1. A pre-existent asthma diagnosis is a risk factor for developing obstructive sleep apnea (OSA) over a 4-year period.
2. The duration of asthma diagnosis has a dose-dependent relationship on the association between asthma and OSA.
Evidence Rating Level: 2 (Good)
Study Rundown: Obstructive sleep apnea (OSA) is a major health concern as it has been implicated in numerous comorbidities, including cardiovascular disease, hypertension, diabetes, obesity and depression. Although certain risk factors such as obesity, craniofacial structural issues and alcohol use have been established as risk factors, the causal relationship of asthma to developing OSA has not been well elucidated. Various studies have suggested a reciprocal relationship between asthma and OSA.
This study aimed to prospectively determine whether asthma is a risk factor for development of OSA. It was found that asthma was indeed a risk factor for developing OSA over a 4-year time frame and that the duration of asthma correlated to the relationship between asthma and OSA. Limitations of this study include lack of objective assessments of the asthma diagnosis in participants and inadequate number of participants to determine the risk of asthma with onset of moderate-severe OSA. Future studies can tackle these limitations as well as determine the etiologic relationship of asthma in causing OSA and the value of screening for OSA in patients with asthma.
Relevant Reading: Obstructive Sleep Apnea Syndrome and Asthma: What are the Links?
In-Depth [prospective cohort study]: This study obtained participants from the Wisconsin Sleep Cohort Study (n=547). Asthma diagnosis was determined by self-reported questionnaire. To be included in the analysis, patients had to be determined as OSA-free at baseline, which was defined as an apnea/hypopnea index (AHI) <5 events/hour and no use of continuous or bilevel positive airway pressure on the first 2 polynsomnography studies. Patients who were determined to be OSA-free were observed for development of incident OSA from baseline with polysnomnography at 4-year intervals. In the end, 22 of 81 participants with asthma developed incident OSA in the first 4-year follow-up period compared to 75 of 466 participants without asthma (p=0.02). The relative risk for incident OSA was 1.39 (95%CI, 1.06-1.82) and 2.72 (95%CI, 1.26-5.89) for incident OSA with habitual sleepiness for patients with pre-existing asthma compared to those without asthma. Five-year increments in the duration of asthma diagnosis were associated with a higher risk of incident OSA and OSA with habitual sleepiness.
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