Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Ng, Susanna S.S.; Chan, Terence; To, Ka–Fai; Chan, Kin-man; Ngai, Jenny; Yip, Wing Ho; Lo, Rachel L.P.; Ko, Fanny W.S.; Hui, David S.

doi:10.1111/resp.13363

Cited by 26 publications

(30 citation statements)

References 42 publications

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“…In some of these cases, the reports also noted decreased airway sensitivity (16) or decreased inflammatory mediator release in obese persons (10), suggesting that the presence of SAS may have a negative effect on BA control. However, other reports indicate that although CPAP ameliorated SAS, this therapy had no effect on BA (9,17). Consequently, no consensus has been achieved, and additional studies are warranted.…”

Section: Discussionmentioning

confidence: 97%

“…In OSAS patients who develop BA, the lower airway stenosis due to BA increases the treatment intractability of OSAS, and BA-associated allergic rhinitis and steroid treatment may further exacerbate OSAS (2,4). Other studies, however, have failed to identify a direct interaction between OSAS and BA (9), and a clear consensus regarding the effects of OSAS and BA on each other has yet to be reached.…”

Section: Introductionmentioning

confidence: 99%

“…Although some studies have shown that treating OSAS in patients with both BA and OSAS enables reduction of BA treatment (10,11), others indicate that this improvement is restricted to the nocturnal symptoms of OSAS and unrelated to respiratory function or BA symptoms (9,12). Therefore, the association between OSAS and BA remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Complicating effects of obstructive sleep apnea syndrome on the severity of adult asthma

et al. 2019

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Introduction: Bronchial asthma (BA) and obstructive sleep apnea syndrome (OSAS) are common causes of respiratory disturbance. Many cases of patients with both conditions have been reported, and BA and OSAS may exacerbate each other, but information remains sparse. Methods: We retrospectively evaluated 60 patients under treatment for BA in our department between April 2016 and March 2018 who also underwent portable polysomnography (PSG) for suspected OSAS to assess potential association between PSG results and asthma treatment or respiratory function. BA was diagnosed and treated according to the Asthma Prevention and Management Guideline 2015. Results: We found that BA treatment intensity step was significantly higher for patients with BA who had concurrent moderate or severe OSAS (p ¼ 0.0016). However, neither respiratory function, fraction of exhaled nitric oxide (FeNO), nor forced oscillation technique (FOT) differed significantly between patients with and without OSAS, and apnea hypopnea index was not significantly correlated with respiratory function, FeNO or FOT parameters. Conclusion: We conclude that even though BA patients with OSAS had good respiratory function, their BA was more severe than that of patients without OSAS, suggesting that OSAS may exacerbate BA. Background factors and asthma parameters were not predictive of PSG results, and patients with suspected OSAS should be evaluated proactively by using PSG.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Complicating effects of obstructive sleep apnea syndrome on the severity of adult asthma

et al. 2019

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“…Within this context, the study by Ng et al . recently published in Respirology is an important advance as they have performed and published the first randomized controlled clinical trial (RCT) in this area . Using limited channel home polysomnography, they screened an appropriate group of patients for the presence of OSA.…”

mentioning

confidence: 99%

“…12 Within this context, the study by Ng et al recently published in Respirology is an important advance as they have performed and published the first randomized controlled clinical trial (RCT) in this area. 13 Using limited channel home polysomnography, they screened an appropriate group of patients for the presence of OSA. Patients had poor asthma control (defined as an asthma control test (ACT) of 19 or below) despite treatment, as well as the presence of recent nocturnal asthma symptoms and habitual snoring.…”

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confidence: 99%

Does CPAP for obstructive sleep apnoea improve asthma control?

Hamilton

2018

Respirology

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Abstract: A high prevalence of OSAS was found among patients with asthma and snoring. CPAP therapy for 3 months did not enhance asthma control but improved daytime sleepiness, quality of life and vitality.

Cited by 26 publications

References 42 publications

Complicating effects of obstructive sleep apnea syndrome on the severity of adult asthma

Complicating effects of obstructive sleep apnea syndrome on the severity of adult asthma

Does CPAP for obstructive sleep apnoea improve asthma control?

Screening for Obstructive Sleep Apnea in Adults

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