Chest
Original ResearchSleep MedicinePredictors of Habitual Snoring and Obstructive Sleep Apnea Risk in Patients With Asthma
Section snippets
Participants
The population included asthma patients returning for routine visits at the University of Michigan Pulmonary Clinics and Asthma-Airways Center. Patients 18 to 75 years old, able, and willing to provide informed consent and complete our survey were included. Those at urgent asthma-related visits and pregnant women were not enrolled. This study was approved by the University of Michigan Institutional Review Board and conducted between May 2004 and April 2006.
Survey Content
The self-administered survey included
Patient Characteristics
Of the 325 patients approached, 303 (93%) completed this survey. Nineteen patients with lung comorbidities (eg, COPD, interstitial lung diseases) were excluded from the analysis.
Among the 284 patients, 143 (50%) had a diagnosis of SDB or met the criteria for high OSA risk. Of the 75 patients (26%) with a known history of OSA and recommended treatment, 40 patients (25 of 49 women [51%] and 15 of 26 men [58%], p = 0.58) were receiving treatment with CPAP. As CPAP could influence asthma control,12
Discussion
This study identifies, for the first time, several factors that may help to explain an increased predisposition for OSA in asthma. Independent predictors of OSA symptoms included more severe asthma, history of GERD, and use of larger doses of ICSs, aside from traditional OSA risk factors such as excess weight and nocturnal nasal congestion. Additionally, these data suggest a reversal of male gender predominance for OSA symptoms in patients with asthma.
This specialty clinic-based, large sample
Acknowledgment
We thank Ashley S. Holland, MPH, Radu C. Nistor, and Jesica M. Pedroza, BS for assistance with administration of screening questionnaires in clinics and data entry. We recognize the help from the physicians at the University of Michigan Pulmonary Clinics and Briarwood Asthma-Airways Center in recruiting patients for this study.
References (56)
- et al.
Symptoms related to obstructive sleep apnoea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population
Respir Med
(2001) - et al.
Longitudinal study of risk factors for habitual snoring in a general adult population: the Busselton Health Study
Chest
(2006) - et al.
Correlates of daytime sleepiness in patients with asthma
Sleep Med
(2006) - et al.
Findings of a Berlin Questionnaire survey: comparison between patients seen in an asthma clinic versus internal medicine clinic
Sleep Med
(2008) - et al.
Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome
Respir Med
(2005) - et al.
Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex: a hypothetical review
Sleep Med Rev
(2007) - et al.
Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population
Sleep Med
(2003) Gastroesophageal reflux: a potential asthma trigger
Immunol Allergy Clin North Am
(2005)Panic disorder and asthma: causes, effects and research implications
J Psychosom Res
(1998)- et al.
Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries
Chest
(2002)
Proximal migration of esophageal acid perfusions during waking and sleep
Am J Gastroenterol
Laryngeal inflammation assessed using the reflux finding score in obstructive sleep apnea
Otolaryngol Head Neck Surg
Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic
Chest
Incidence and remission of habitual snoring over a 5- to 6-year period
Chest
Obesity and asthma: possible mechanisms
J Allergy Clin Immunol
Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire
J Clin Anesth
Fast stats A to Z: asthma prevalence, health care use and mortality; United States 2003–2005
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
Snoring, asthma and sleep disturbance in Britain: a community-based survey
Eur Respir J
Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three European countries
Eur Respir J
Difficult-to-control asthma and obstructive sleep apnea
J Asthma
Symposium on obesity and asthma - November 2, 2006
Can Respir J
Nocturnal asthma: role of snoring and obstructive sleep apnea
Am Rev Respir Dis
Nocturnal asthma: snoring, small pharynx and nasal CPAP
Eur Respir J
Impact of CPAP on asthmatic patients with obstructive sleep apnoea
Eur Respir J
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007
J Allergy Clin Immunol
Obstructive sleep apnea, inflammation, and cardiopulmonary disease
Front Biosci
Cited by (0)
This work was performed at the University of Michigan Health System, Ann Arbor, MI.
This research was supported by University of Michigan General Clinical Research Center grant MO1 RR00042 (to M.T.) and University of Michigan Department of Neurology Training Grant T32 NS007222 (to M.T.).
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
- 1
Dr. Teodorescu has received funding from the University of Wisconsin School of Medicine and Public Health, Department of Medicine and from Medical Education and Research Committee New Investigator Award to continue asthma-sleep apnea research.
- 2
Dr. Coffey has received research funds from the University of Michigan.
- 3
Dr. Chervin has consulted on the subjects of sleep or sleep apnea for Respironics, Inc, Pavad Medical, Inc, Alexa Pharmaceuticals, Inc, several legal firms, and US District Attorney (each for under $10,000). He is named in a University of Michigan patent on a sleep apnea-related signal analysis algorithm. The other authors have no conflicts of interest to disclose.