Association between lung function decline and obstructive sleep apnoea: the ALEC study

Emilsson, Össur Ingi; Sundbom, Fredrik; Ljunggren, Mirjam; Benediktsdóttir, Bryndís; Garcia‐Aymerich, Judith; Bui, Dinh; Jarvis, Déborah; Olin, Anna Carin; Franklin, Karl A.; Demoly, Pascal; Lindberg, Eva; Janson, Christer; Aspelund, Thor; Gíslason, Þórarinn

doi:10.1007/s11325-020-02086-1

Cited by 22 publications

(18 citation statements)

References 31 publications

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“…Therefore, the conflicting results may be because asthma is more severe or difficult to control in the presence of severe OSA, requiring higher levels of asthmatic treatment that presents a better baseline lung function. In addition, OSA was associated with more rapid lung function decline per year in patients with asthma and OSA severity had an essential effect on the rate of decline [ 12 , 58 ]. Guidelines advise that %FEV 1 < 60% determines that a patient is at risk of future asthma exacerbations [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

et al. 2023

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Background There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa. Methods We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I2 statistics. We also performed subgroup analysis, Meta-regression, and Egger’s test for bias analysis. Results 34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763–0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16–1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49–7.64). Conclusion OSA was associated with more severe or difficult-to-control asthma with decreased %FEV1 in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

et al. 2023

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“… 25 , 55 Additionally, patients in the current study had mean 48 years of age, similar to small studies from Algeria, 32 India 27 and Serbia, 28 yet significantly younger than European studies. 25 , 26 , 46 , 56 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Lung Function Parameters on Sleep Among Aboriginal Australians – A Polysomnography and Spirometry Relationship Study

Howarth¹,

Saad²,

Heraganahally³

2023

NSS

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Background Sleep disorders such as obstructive sleep apnoea (OSA) are known to overlap significantly with airway diseases in various populations. This study assessed the relationship between lung function parameters against polysomnography (PSG) and continuous positive airway pressure (CPAP) adherence data amongst an Aboriginal Australian population. Methods Patients who undertook both a diagnostic PSG and spirometry were included. Restrictive, obstructive, and mixed impairments were assessed via global lung function initiative (GLI-2012, ATS/ERS) criteria/guidelines. PSG and CPAP data were evaluated between patients with or without spirometry impairments. Results Of the total 771 patients, 248 had PSG and spirometry data available (52% female, 44% remote residents, 78% obese). The majority (89%) had OSA (51% severe), 95 (38%) were observed to have a restrictive impairment, and 31 (13%) had an obstructive or mixed impairment on spirometry. Compared to patients with no spirometric impairment, those with restrictive or obstructive/mixed impairments demonstrated significantly lower sleep efficiency (median 84% vs 79% and 78%), higher apnoea-hypopnea index (AHI) during rapid eye movement (REM) sleep (median 32 vs 52 and 55 events/hour), reduced REM oxygen saturation (SpO 2 ) (median 94.0% vs 92.0% and 92.5%) and reduced adherence to CPAP therapy (median 39% vs 22% and 17%). Differences in sleep efficiency, REM AHI, and NREM SpO 2 held for patients with obstructive/mixed impairments in multivariate modelling. Conclusion Aboriginal Australian patients with OSA have a higher concurrent lung function’ impairment. Spirometric impairment appears to negatively influence sleep efficiency, nocturnal SpO 2 and CPAP adherence. This may have substantial implications for OSA management among Aboriginal Australians.

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“…If intrapleural pressures are not present effectively (with a decrease in pulmonary inflation), the C-type lung afferent fibers send inhibitory information to the hypoglossal nerve; this mechanism will slow down the intervention of the lingual musculature, compared to the activation of the diaphragm, with the possible collapse of the airways [111,112]. If the relationship between DM and pulmonary inflation is not effective, there will be an increase in the finding of OSA [113]. Pressure intrathoracic is not directly related to AHI values, and airflow limitation is seen in many patients during daylight hours, to a greater extent than polysomnography evaluation alone [114].…”

Section: Functional Anatomy and Adaptation Of The Diaphragm Muscle Wi...mentioning

confidence: 99%

Obstructive Sleep Apnea and Role of the Diaphragm

Bordoni¹,

Escher²,

Toccafondi³

et al. 2022

Cureus

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Obstructive sleep apnea (OSA) causes multiple local and systemic pathophysiological consequences, which lead to an increase in morbidity and mortality in patients suffering from this disorder. OSA presents with various nocturnal events of apnoeas or hypopneas and with sub-clinical airflow limitations during wakefulness. OSA involves a large percentage of the population, particularly men, but the estimate of OSA patients could be much broader than data from the literature. Most of the research carried out in the muscle field is to understand the causes of the presence of chronic nocturnal desaturation and focus on the genioglossus muscle and other muscles related to dilating the upper airways. Sparse research has been published regarding the diaphragm muscle, which is the main muscle structure to insufflate air into the airways. The article reviews the functional anatomy of the muscles used to open the upper respiratory tract and the non-physiological adaptation that follows in the presence of OSA, as well as the functional anatomy and pathological adaptive aspects of the diaphragm muscle. The intent of the text is to highlight the disparity of clinical interest between the dilator muscles and the diaphragm, trying to stimulate a broader approach to patient evaluation.

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Association between lung function decline and obstructive sleep apnoea: the ALEC study

Cited by 22 publications

References 31 publications

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

The Impact of Lung Function Parameters on Sleep Among Aboriginal Australians – A Polysomnography and Spirometry Relationship Study

Obstructive Sleep Apnea and Role of the Diaphragm

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