Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

Abstract

BackgroundWe hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP.MethodsWe performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.FindingsNo significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29–6·44, p = 0·01). Patients with severe OSA (AHI≥30) also had a higher risk of CAP (OR = 3·18, 95%CI 1·11–11·56, p = 0·047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007). Furthermore, OSA was significantly associated with CAP severity (p = 0·0002), and OSA severity was also associated with CAP severity (p = 0·0006).ConclusionsOSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the relationships among gastroesophageal reflux, silent aspiration, laryngeal sensory dysfunction and CAP.Trial RegistrationClinicalTrials.gov NCT01071421

Sleep apnoea and risk of post-operative infection: beyond cardiovascular impact

“…Although the study's main outcome (a broad composite of variables associated with post-operative mortality and a range of post-operative complications) showed no discrepancy between the group with excessive SDB and the group with a normal or near-normal SDB, this was not true of the incidence of sepsis and pneumonia, which were higher, particularly in the untreated forms of moderate to severe sleep apnoea. This association between sleep apnoea and various infections, already demonstrated by other previous studies [4,6,7], emphasises the importance of moving beyond an exclusive focus on the analysis of the cardiovascular impact of sleep apnoea (even in patients with a high cardiovascular risk, as in the study in question) and exploring other possibilities in which SDB could have potentially preventable or treatable consequences.There is a sufficiently plausible biological explanation for an increase in the number of post-operative infectious complications in patients with sleep apnoea. The coordination between respiration and swallowing…”

Profiling of lung microbiota in the patients with obstructive sleep apnea

“…OSA patients are predisposed to increased microaspiration and gastric reflux, [ 15 ] and it has been reported that OSA patients had an increased risk of community-acquired pneumonia. [ 16 ] Therefore, the current study was designed to investigate lower airway microbiota in OSA patients in comparison to that of control subjects with respiratory diseases other than OSA. We demonstrated that there was diverse microbiome in the airways of OSA patients and control subjects.…”

Hypoxia-induced PD-L1/PD-1 crosstalk impairs T-cell function in sleep apnoea

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