Asthma and Obstructive Sleep Apnea Overlap: What Has the Evidence Taught Us?

Prasad, Bharati; Nyenhuis, Sharmilee M.; Imayama, Ikuyo; Siddiqi, Aminaa; Teodorescu, Mihaela

doi:10.1164/rccm.201810-1838tr

Cited by 98 publications

(67 citation statements)

References 95 publications

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“…OSA could result from altered breathing control due to systematic inflammation and neuroimmune cross‐talk from asthma. Furthermore, the effect of inhaled corticosteroid treatment on muscle and fat composition may affect the anatomy of the upper airway, predisposing children to OSA 23 . Conversely, OSA‐associated chronic intermittent hypoxemia could modulate airway inflammation, and consequently lead to decreased response to asthma treatment 24,25 …”

Section: Discussionmentioning

confidence: 99%

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Tsou

Cielo

Xanthopoulos

et al. 2021

Pediatric Pulmonology

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Objective To determine the impact of obstructive sleep apnea (OSA) on asthma exacerbation severity in children hospitalized for asthma exacerbation. Hypothesis OSA is associated with greater use of invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIMV) in children hospitalized for asthma exacerbation. Study Design A retrospective cohort study. Patient–Subject Selection Hospitalization records of children aged 2–18 years admitted for acute asthma exacerbation were obtained for 2000, 2003, 2006, 2009, and 2012 from the Kids’ Inpatient Database. Methodology The primary exposure was OSA, the primary outcome was IMV, and secondary outcomes were NIMV, length of hospital stay (LOS), and inflation‐adjusted cost of hospitalization. Multivariable logistic regression, negative binomial, and linear regression were conducted to ascertain the impact of OSA on primary and secondary outcomes. Exploratory analyses investigated the impact of obesity on primary and secondary outcomes. Results Among 564,467 hospitalizations for acute asthma exacerbation, 4209 (0.75%) had OSA. Multivariable regression indicated that OSA was associated with IMV (adjusted odds ratio [OR], 5.33 [95% confidence interval, CI: 4.35–6.54], p < .0001), NIMV (adjusted OR, 8.30 [95% CI: 6.56–10.51], p < .0001), longer LOS (adjusted incidence rate ratio, 1.34 [95% CI 1.28–1.43], p < .0001), and greater inflation‐adjusted cost of hospitalization (adjusted β, 0.38 [95% CI: 0.33–0.43], p < .0001). Obesity was also significantly associated IMV, NIMV, longer LOS, and greater inflation‐adjusted cost of hospitalization. There was no interaction between OSA and obesity. Conclusion OSA is an independent risk factor for IMV, NIMV, longer LOS, and elevated inflation‐adjusted costs of hospitalization in children hospitalized for asthma exacerbation.

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Section: Discussionmentioning

confidence: 99%

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Tsou

Cielo

Xanthopoulos

et al. 2021

Pediatric Pulmonology

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“…Asthma and sleep apnea share many predisposing and aggravating factors; asthma is often accompanied by snoring and apnea, and sleep apnea often combines with asthma. The two diseases present many similar features [ 29 , 30 ] and recent studies have shown that asthma and sleep apnea share a bidirectional relationship where each disorder adversely influences the other one [ 30 , 31 ]. As reported in a US study, unrecognized sleep apnea could be a reason for persistent asthma symptoms during the day and the night [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Asthma Patterns in Italian Adult General Population Samples: Host and Environmental Risk Factors

Maio

Baldacci

Simoni

et al. 2020

JCM

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Background: Asthma patterns are not well established in epidemiological studies. Aim: To assess asthma patterns and risk factors in an adult general population sample. Methods: In total, 452 individuals reporting asthma symptoms/diagnosis in previous surveys participated in the AGAVE survey (2011–2014). Latent transition analysis (LTA) was performed to detect baseline and 12-month follow-up asthma phenotypes and longitudinal patterns. Risk factors associated with longitudinal patterns were assessed through multinomial logistic regression. Results: LTA detected four longitudinal patterns: persistent asthma diagnosis with symptoms, 27.2%; persistent asthma diagnosis without symptoms, 4.6%; persistent asthma symptoms without diagnosis, 44.0%; and ex -asthma, 24.1%. The longitudinal patterns were differently associated with asthma comorbidities. Persistent asthma diagnosis with symptoms showed associations with passive smoke (OR 2.64, 95% CI 1.10–6.33) and traffic exposure (OR 1.86, 95% CI 1.02–3.38), while persistent asthma symptoms (without diagnosis) with passive smoke (OR 3.28, 95% CI 1.41–7.66) and active smoke (OR 6.24, 95% CI 2.68–14.51). Conclusions: LTA identified three cross-sectional phenotypes and their four longitudinal patterns in a real-life setting. The results highlight the necessity of a careful monitoring of exposure to active/passive smoke and vehicular traffic, possible determinants of occurrence of asthma symptoms (with or without diagnosis). Such information could help affected patients and physicians in prevention and management strategies.

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“…Asthma is a severe chronic inflammatory disease with an increasing prevalence worldwide ( 1 , 2 ). The pathogenesis of asthma involves complicated factors, including immunity, infection, environmental factors and genetic inheritance ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

miR‑106b‑5p targeting SIX1 inhibits TGF‑β1‑induced pulmonary fibrosis and epithelial‑mesenchymal transition in asthma through regulation of E2F1

et al. 2021

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Asthma is an inflammatory disease of the airways, characterized by lung eosinophilia, mucus hypersecretion by goblet cells and airway hyper-responsiveness to inhaled allergens. The present study aimed to identify the function of microRNA (miR/miRNA)-106b-5p in TGF-β1-induced pulmonary fibrosis and epithelial-mesenchymal transition (EMT) via targeting sine oculis homeobox homolog 1 (SIX1) through regulation of E2F transcription factor 1 (E2F1) in asthma. Asthmatic mouse models were induced with ovalbumin. miRNA expression was evaluated using reverse transcription-quantitative PCR. Transfection experiments using bronchial epithelial cells were performed to determine the target genes. A luciferase reporter assay system was applied to identify the target gene of miR-106b-5p. The present study revealed downregulated miR-106b-5p expression and upregulated SIX1 expression in asthmatic mice and TGF-β1-induced BEAS-2B cells. Moreover, miR-106b-5p overexpression inhibited TGF-β1-induced fibrosis and EMT in BEAS-2B cells, while miR-106b-5p-knockdown produced the opposite effects. Subsequently, miR-106b-5p was found to regulate SIX1 through indirect regulation of E2F1. Additionally, E2F1- and SIX1-knockdown blocked TGF-β1-induced fibrosis and EMT in BEAS-2B cells. In addition, miR-106b-5p negatively regulated SIX1 via E2F1 in BEAS-2B cells. The present study demonstrated that the miR-106b-5p/E2F1/SIX1 signaling pathway may provide potential therapeutic targets for asthma.

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Asthma and Obstructive Sleep Apnea Overlap: What Has the Evidence Taught Us?

Cited by 98 publications

References 95 publications

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation

Longitudinal Asthma Patterns in Italian Adult General Population Samples: Host and Environmental Risk Factors

miR‑106b‑5p targeting SIX1 inhibits TGF‑β1‑induced pulmonary fibrosis and epithelial‑mesenchymal transition in asthma through regulation of E2F1

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