Screening for obstructive sleep apnea syndrome in asthma patients: a prospective study based on Berlin and STOP-Bang questionnaires

Abstract

Background: The bidirectional relationship of asthma and obstructive sleep apnea (OSA) has been confirmed in recent years. However, in the clinical practice, majority of asthma patients did not pay adequate attention to their sleep apnea condition. Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) are two most common OSA screening questionnaires to screen high-risk patients for OSA. This study aimed at evaluating the predictive performance of BQ and SBQ for OSA in asthma patients.Methods: Asthma outpatients of Zhongshan Hospital were enrolled into the study. All patients were asked to fill in the BQ and SBQ and clinical characteristics and asthma characteristics were recorded. Univariate and multivariate logistic regression analyses were applied to identify risk factors of OSA in asthma patients.With the gold standard of laboratory-based overnight polysomnography (PSG), the predictive performance of SBQ and BQ was evaluated and compared. The probability of OSA severity was predicted by various SBQ scores in asthma patients.Results: A total of 123 asthma patients (average age 47.56±12.12 years; 57.72% males) were enrolled and underwent PSG diagnosis overnight at Sleep Center. Logistic regression analyses showed that rhinitis (adjusted OR =4.30; 95% CI: 1.50-12.37, P=0.007) and dyslipidemia (adjusted OR =2.75; 95% CI: 1.16-6.51, P=0.021) were associated with OSA in asthma patients after adjusting for known OSA risk factors. No asthma functional characteristic differences were found to be associated with OSA severity in the study. The prevalence of moderate-to-severe OSA (AHI ≥15) in the asthmatic population sample was 36.59% (45/123).Questionnaires predictive results showed that compared with BQ, SBQ has higher diagnostic sensitivity (84.4% vs. 60%), lower specificity (79.5% vs. 91%) lower positive predictive value (PPV): (70.4% vs. 79.4%) and higher negative predictive value (NPV) (90% vs. 80%) to detect moderate-to-severe OSA at the cutoff as AHI of 15/h. OSA probability results showed that with the increasing of the questionnaire scores, the moderate and severe OSA probability of SBQ rose significantly.Conclusions: SBQ is a preferable sleep questionnaire better than BQ for detecting moderate and severe OSA in asthma patients which should be validated in larger population sample.

Is there any asociation between obstructive sleep apnea (OSA) and aspirin-exacerbated respiratory disease (AERD)? Does aspirin desensitization affect OSA risk?

“…On the other hand epidemiologic data showed that asthmatic populations have OSA ranges from 38-70% [20]. In a recent prospective study for screening OSA in asthma patients, 63.41% of the subjects have OSA but in asthma accompanied by a rhinitis 85 % have OSA; In this study they specified that 49.59% were mild, 43.9% were moderate 6.5% were severe asthma and mean FEV1 was 87.63 % [21]. In our study according to drug history 72.72% of the ATRD group were taking low dose inhaler steroid combined with longacting beta2 agonist (3'th step to GINA; moderate) others were taking 4'th step (severe), but our all of the AERD patient's treatment were at least 4'th step and 2 of them taking also omalizumab treatment.…”

Polysomnographic variables in Alternate overlap syndrome: data from sleep heart health study

“…OSA and asthma are both highly prevalent conditions. Epidemiologic data show the prevalence of OSA as high as 70% among asthmatics [14,15]. Asthma and OSA share several risk factors together like obesity, smoking, gastroesophageal reflux, sinoatrial disease and systemic inflammation [16].…”

“…Since its introduction by Sullivan in 1981, CPAP has been the main line of treatment for OSA [18]. Growing evidence suggests bidirectional effects of OSA with asthma and better outcomes of asthma treated with CPAP in patients with concomitant OSA [14,[19][20][21]. Effects of asthma on OSA involves mechanical factors (increased airway resistance during REM sleep due to reduction in Functional Residual capacity and End Expiratory Lung Volume leading to upper airway collapse and worsening of apnea), Smoking (directly increasing airway edema and resistance), Corticosteroids use (causing airway myopathy, obesity and airway fat deposition) and increased nasal resistance due to rhinitis or polyps.…”

Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

“…Asthma is a chronic inflammatory disorder of the airways leading to hyperresponsiveness with more symptoms at night. High prevalence of OSAS symptoms and moderate‐to‐severe OSAS has been reported in the asthmatic populations . Previous non‐randomized studies showed that continuous positive airway pressure (CPAP) treatment conferred a positive impact on asthma outcomes in patients with concomitant OSAS .…”

“…High prevalence of OSAS symptoms and moderate-to-severe OSAS has been reported in the asthmatic populations. [4][5][6][7] Previous nonrandomized studies showed that continuous positive airway pressure (CPAP) treatment conferred a positive impact on asthma outcomes in patients with concomitant OSAS. [8][9][10][11] In this study, we aimed to assess asthma…”