Background: Unrecognized obstructive sleep apnea (OSA) may lead to poor asthma control despite optimal therapy. Our objective was to evaluate the relationship between OSA risk and asthma control in adults. Methods: Patients with asthma seen routinely at tertiary-care clinic visits completed the validated Sleep Apnea Scale of the Sleep Disorders Questionnaire (SA-SDQ) and Asthma Control Questionnaire (ACQ). An ACQ score of Ն 1.5 defi ned not-well-controlled asthma, and an SA-SDQ score of Ն 36 for men and Ն 32 for women defi ned high OSA risk. Logistic regression was used to model associations of high OSA risk with not-well-controlled asthma (ACQ full version and short versions). Results: Among 472 subjects with asthma, the mean 6 SD ACQ (full version) score was 0.87 6 0.90, and 80 (17%) subjects were not well controlled. Mean SA-SDQ score was 27 6 7, and 109 (23%) subjects met the defi nition of high OSA risk. High OSA risk was associated, on average, with 2.87-times higher odds for not-well-controlled asthma (ACQ full version) (95% CI, 1.54-5.32; P 5 .0009) after adjusting for obesity and other factors known to worsen asthma control. Similar independent associations were seen when using the short ACQ versions. Conclusions: High OSA risk is signifi cantly associated with not-well-controlled asthma independent of known asthma aggravators and regardless of the ACQ version used. Patients who have diffi culty achieving adequate asthma control should be screened for OSA.CHEST 2010; 138(3):543-550Abbreviations: ACQ 5 Asthma Control Questionnaire; CPAP 5 continuous positive airway pressure; GERD 5 gastroesophageal refl ux disease; OSA 5 obstructive sleep apnea; PEFR 5 peak expiratory fl ow rate; PSG 5 polysomnography; SA-SDQ 5 Sleep Apnea Scale of the Sleep Disorders Questionnaire

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Background/Objectives. Asthma in older individuals is poorly understood. We aimed to characterize the older asthma phenotype and test its association with obstructive sleep apnea (OSA). Design. Cross-sectional. Setting. Pulmonary and Asthma/Allergy clinics. Participants. 659 asthma subjects aged 18–59 years (younger) and 154 aged 60–75 (older). Measurements. Sleep Apnea scale of Sleep Disorders Questionnaire (SA-SDQ), asthma severity step (1–4, severe if step 3 or 4), established OSA diagnosis, continuous positive airway pressure (CPAP) use, and comorbidities. Results. Older versus younger had worse control, as assessed by asthma step, lung function, and inhaled corticosteroid use. Among older subjects, after controlling for known asthma aggravators, OSA diagnosis was the only factor robustly associated with severe asthma: on average, OSA was associated with nearly 7 times greater likelihood of severe asthma in an older individual (OR = 6.67). This relationship was of greater magnitude than in younger subjects (OR = 2.16). CPAP use attenuated the likelihood of severe asthma in older subjects by 91% (P = 0.005), much more than in the younger asthmatics. Conclusion. Diagnosed OSA increases the risk for worse asthma control in older patients, while CPAP therapy may have greater impact on asthma outcomes. Unrecognized OSA may be a reason for poor asthma control, particularly among older patients.

Background Obesity is more prevalent in asthmatics. Short sleep duration is a novel risk factor for obesity in general populations. Objective We tested the association of sleep duration and asthma characteristics with obesity. Methods Adults at tertiary clinics were surveyed on asthma symptoms and habitual sleep duration. Medical records were used to assess asthma severity step (1-4), extract height and weight, current medications and diagnosed comorbid conditions. BMI≥30 kg/m2 defined obesity. Habitual sleep was categorized as <6 (very short), 6 to <7h (short), 7-8h (normal), >8 to ≤9h (long) and >9h (very long). Inhaled corticosteroid doses were categorized as low, moderate and high. Results Among 611 participants (mean BMI 30±8), 249 (41%) were obese. After adjustment for covariates, obesity was associated with short and very long sleep: as compared to normal sleepers, the odds of being obese were on average 66% higher ([95% Confidence Interval: 1.07-2.57], p=0.02) among short and 124% higher ([1.08-1.65], p=0.03) among very long sleepers, and the association with very short sleep approached significance (1.74 [0.96-3.14], p=0.06). Obesity was also significantly related to highest asthma step (1.87 [1.09-3.21], p=0.02) and psychopathology (1.64 [1.08-2.48], p=0.02), and a trend was seen with high dose inhaled corticosteroids (1.82 [0.93-3.56], p=0.08). Conclusions Obesity in asthmatics is associated with shorter and very long sleep duration, worse asthma severity, psychopathology, and high dose inhaled corticosteroids. Although this cross-sectional study cannot prove causality, we speculate that further investigation of sleep may provide new opportunities to reduce the rising prevalence of obesity among asthmatics.