Obstructive Sleep Apnea Syndrome (OSAS) and Asthma: A Simple Association: A New Syndrome or a Cluster?

Caterina Antonaglia*

Caterina Antonaglia*

Volume3-Issue8
Dates: Received: 2022-08-01 | Accepted: 2022-08-18 | Published: 2022-08-21
Pages: 944-952

Abstract

Obstructive Sleep Apnea Syndrome (OSAS) and Asthma are two diseases with a high epidemiological impact that may coexist in some patients with the name of Alternative Overlap Syndrome. Both diseases have underlying pathogenic mechanisms (chronic inflammation, genetic predisposition etc). Epidemiological data suggest that the coexistence of OSA and asthma, also known as “Alternative Overlap Syndrome” has an adverse impact on health outcomes. Asthma and OSA overlap with similar comorbidities and underlying pathophysiology, potentiating the two conditions. The most common comorbidities associated with both diseases are Gastro-Esophageal Reﬂux Disease (RGE), rhinosinusitis and obesity. Neuromechanical reflex bronchoconstriction, local and systemic inflammation, the indirect effect on dyspnea of OSAS-induced cardiac dysfunction, angiogenesis and leptin-related airway changes may all play a common mechanistic role linking both disorders.

FullText HTML FullText PDF DOI: 10.37871/jbres1537

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How to cite this article

Antonaglia C. Obstructive Sleep Apnea Syndrome (OSAS) and Asthma: A Simple Association: A New Syndrome or a Cluster? J Biomed Res Environ Sci. 2022 Aug 21; 3(8): 944-952. doi: 10.37871/jbres1537, Article ID: JBRES1537, Available at: https://www.jelsciences.com/articles/jbres1537.pdf

Subject area(s)

Sleep Disorders

Respiratory Medicine

Pulmonology

References

Hudgel DW, Shucard DW. Coexistence of sleep apnea and asthma resulting in severe sleep hypoxemia. JAMA. 1979 Dec 21;242(25):2789-90. PMID: 501891.
Umashankar N, Agarwal KC, Purohit G, Choudhary CR, Deepak UG. Alternate overlap syndrome: Association of asthma with obstructive sleep apnea. Eur Respir J. 2016; 48: suppl 60.doi: 10.1183/13993003.
Bethesda. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. US : National Heart, Lung, and Blood Institute; 2007.
Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015 Aug;7(8):1311-22. doi: 10.3978/j.issn.2072-1439.2015.06.11. PMID: 26380759; PMCID: PMC4561280.
Goldstein C, Zee PC. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010 Nov 15;182(10):1332; author reply 1332-3. doi: 10.1164/ajrccm.182.10.1332a. PMID: 21079268.
Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, Ancoli-Israel S, Stone KL. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011 Aug 10;306(6):613-9. doi: 10.1001/jama.2011.1115. PMID: 21828324; PMCID: PMC3600944.
Kirkness JP, Schwartz AR, Schneider H, Punjabi NM, Maly JJ, Laffan AM, McGinley BM, Magnuson T, Schweitzer M, Smith PL, Patil SP. Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. J Appl Physiol (1985). 2008 Jun;104(6):1618-24. doi: 10.1152/japplphysiol.00045.2008. Epub 2008 Apr 17. PMID: 18420722; PMCID: PMC2474771.
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76. PMID: 19960649; PMCID: PMC2699173.
Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, Guilleminault C, Dement WC. The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ. Sleep. 1994 Mar;17(2):160-7. doi: 10.1093/sleep/17.2.160. PMID: 8036370.
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008 May;108(5):812-21. doi: 10.1097/ALN.0b013e31816d83e4. PMID: 18431116.
AIPO Ricerche. Raccomandazioni per la diagnosi e cura dei disturbi respiratori nel sonno. AIPO Ricerche; 2020.
Eckert DJ. Phenotypic approaches to obstructive sleep apnoea - New pathways for targeted therapy. Sleep Med Rev. 2018 Feb;37:45-59. doi: 10.1016/j.smrv.2016.12.003. Epub 2016 Dec 18. PMID: 28110857.
Adattamento GINA Italia. GINASMA. 2022.
Luyster FS, Teodorescu M, Bleecker E, Busse W, Calhoun W, Castro M, Chung KF, Erzurum S, Israel E, Strollo PJ, Wenzel SE. Sleep quality and asthma control and quality of life in non-severe and severe asthma. Sleep Breath. 2012 Dec;16(4):1129-37. doi: 10.1007/s11325-011-0616-8. Epub 2011 Nov 20. PMID: 22102290; PMCID: PMC3617495.
Damianaki A, Vagiakis E, Sigala I, Pataka A, Rovina N, Vlachou A, Krietsepi V, Zakynthinos S, Katsaounou P. Τhe Co-Existence of Obstructive Sleep Apnea and Bronchial Asthma: Revelation of a New Asthma Phenotype? J Clin Med. 2019 Sep 16;8(9):1476. doi: 10.3390/jcm8091476. PMID: 31527545; PMCID: PMC6780801.
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, Adcock IM, Bateman ED, Bel EH, Bleecker ER, Boulet LP, Brightling C, Chanez P, Dahlen SE, Djukanovic R, Frey U, Gaga M, Gibson P, Hamid Q, Jajour NN, Mauad T, Sorkness RL, Teague WG. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014 Feb;43(2):343-73. doi: 10.1183/09031936.00202013. Epub 2013 Dec 12. Erratum in: Eur Respir J. 2014 Apr;43(4):1216. Dosage error in article text. Erratum in: Eur Respir J. 2018 Jul 27;52(1): Erratum in: Eur Respir J. 2022 Jun 9;59(6): PMID: 24337046.
ten Brinke A, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, Rabe KF, Bel EH. Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J. 2005 Nov;26(5):812-8. doi: 10.1183/09031936.05.00037905. PMID: 16264041.
Teodorescu M, Polomis DA, Gangnon RE, Fedie JE, Consens FB, Chervin RD, Teodorescu MC. Asthma Control and Its Relationship with Obstructive Sleep Apnea (OSA) in Older Adults. Sleep Disord. 2013;2013:251567. doi: 10.1155/2013/251567. Epub 2013 Nov 6. PMID: 24307949; PMCID: PMC3836422.
Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008 Aug;31(8):1071-8. PMID: 18714778; PMCID: PMC2542952.
Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemière C, Pepe C, Naor N, Olha A, Kimoff RJ. Prevalence of obstructive sleep apnea-hypopnea in severe versus moderate asthma. J Allergy Clin Immunol. 2009 Aug;124(2):371-6. doi: 10.1016/j.jaci.2009.05.016. Epub 2009 Jun 26. PMID: 19560194.
Antonaglia C, Passuti G, Giudici F, Salton F, Ruaro B, Radovanovic D, Confalonieri M. Low arousal threshold: a common pathophysiological trait in patients with obstructive sleep apnea syndrome and asthma. Sleep Breath. 2022 Jul 30. doi: 10.1007/s11325-022-02665-4. Epub ahead of print. PMID: 35907116.
Prasad B, Nyenhuis SM, Imayama I, Siddiqi A, Teodorescu M. Asthma and Obstructive Sleep Apnea Overlap: What Has the Evidence Taught Us? Am J Respir Crit Care Med. 2020 Jun 1;201(11):1345-1357. doi: 10.1164/rccm.201810-1838TR. PMID: 31841642; PMCID: PMC7258643.
Kong DL, Qin Z, Shen H, Jin HY, Wang W, Wang ZF. Association of Obstructive Sleep Apnea with Asthma: A Meta-Analysis. Sci Rep. 2017 Jun 22;7(1):4088. doi: 10.1038/s41598-017-04446-6. PMID: 28642543; PMCID: PMC5481327.
Teodorescu M, Barnet JH, Hagen EW, Palta M, Young TB, Peppard PE. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015 Jan 13;313(2):156-64. doi: 10.1001/jama.2014.17822. Erratum in: JAMA. 2015 Jul 7;314(1):86. PMID: 25585327; PMCID: PMC4334115.
Yigla M, Tov N, Solomonov A, Rubin AH, Harlev D. Difficult-to-control asthma and obstructive sleep apnea. J Asthma. 2003 Dec;40(8):865-71. doi: 10.1081/jas-120023577. PMID: 14736085.
Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemière C, Pepe C, Naor N, Olha A, Kimoff RJ. Prevalence of obstructive sleep apnea-hypopnea in severe versus moderate asthma. J Allergy Clin Immunol. 2009 Aug;124(2):371-6. doi: 10.1016/j.jaci.2009.05.016. Epub 2009 Jun 26. PMID: 19560194.
Turino C, Bertran S, Gavaldá R, Teixidó I, Woehrle H, Rué M, Solsona F, Escarrabill J, Colls C, García-Altés A, de Batlle J, Sánchez de-la-Torre M, Barbé F. Characterization of the CPAP-treated patient population in Catalonia. PLoS One. 2017 Sep 21;12(9):e0185191. doi: 10.1371/journal.pone.0185191. PMID: 28934303; PMCID: PMC5608364.
Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest. 2020 Feb;157(2):403-420. doi: 10.1016/j.chest.2019.09.002. Epub 2019 Sep 17. PMID: 31539538; PMCID: PMC7005379.
Janson C, Gislason T, Boman G, Hetta J, Roos BE. Sleep disturbances in patients with asthma. Respir Med. 1990 Jan;84(1):37-42. doi: 10.1016/s0954-6111(08)80092-3. PMID: 2371419.
Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007 Apr 1;175(7):661-6. doi: 10.1164/rccm.200611-1717OC. Epub 2007 Jan 18. PMID: 17234901; PMCID: PMC1899288.
Mackay TW, Fitzpatrick MF, Douglas NJ. Non-adrenergic, non-cholinergic nervous system and overnight airway calibre in asthmatic and normal subjects. Lancet. 1991 Nov 23;338(8778):1289-92. doi: 10.1016/0140-6736(91)92591-o. PMID: 1682685.
Hetzel MR, Clark TJ. Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax. 1980 Oct;35(10):732-8. doi: 10.1136/thx.35.10.732. PMID: 7466721; PMCID: PMC471372.
Kasasbeh A, Kasasbeh E, Krishnaswamy G. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex--a hypothetical review. Sleep Med Rev. 2007 Feb;11(1):47-58. doi: 10.1016/j.smrv.2006.05.001. Epub 2007 Jan 2. PMID: 17198758.
Fredberg JJ, Inouye DS, Mijailovich SM, Butler JP. Perturbed equilibrium of myosin binding in airway smooth muscle and its implications in bronchospasm. Am J Respir Crit Care Med. 1999 Mar;159(3):959-67. doi: 10.1164/ajrccm.159.3.9804060. PMID: 10051279.
Elliot JG, Donovan GM, Wang KCW, Green FHY, James AL, Noble PB. Fatty airways: implications for obstructive disease. Eur Respir J. 2019 Dec 12;54(6):1900857. doi: 10.1183/13993003.00857-2019. PMID: 31624112.
Mahdavinia M, Schleimer RP, Keshavarzian A. Sleep disruption in chronic rhinosinusitis. Expert Rev Anti Infect Ther. 2017 May;15(5):457-465. doi: 10.1080/14787210.2017.1294063. Epub 2017 Feb 17. PMID: 28276943; PMCID: PMC5967413.
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011 Sep;268(9):1365-73. doi: 10.1007/s00405-010-1469-7. Epub 2011 Feb 22. PMID: 21340561; PMCID: PMC3149667.
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011 Sep;268(9):1365-73. doi: 10.1007/s00405-010-1469-7. Epub 2011 Feb 22. PMID: 21340561; PMCID: PMC3149667.
Orr WC, Elsenbruch S, Harnish MJ, Johnson LF. Proximal migration of esophageal acid perfusions during waking and sleep. Am J Gastroenterol. 2000 Jan;95(1):37-42. doi: 10.1111/j.1572-0241.2000.01669.x. PMID: 10638556.
Samelson CF. Gastroesophageal reflux and obstructive sleep apnea. Sleep. 1989 Oct;12(5):475-6. doi: 10.1093/sleep/12.5.475. PMID: 2799220.
Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med. 2009 Feb 15;5(1):71-8. PMID: 19317386; PMCID: PMC2637171.
Cropp GJ. Effectiveness of bronchodilators in cystic fibrosis. Am J Med. 1996 Jan 29;100(1A):19S-29S. doi: 10.1016/s0002-9343(96)80049-0. PMID: 8610713.
Guler N, Kirerleri E, Ones U, Tamay Z, Salmayenli N, Darendeliler F. Leptin: does it have any role in childhood asthma? J Allergy Clin Immunol. 2004 Aug;114(2):254-9. doi: 10.1016/j.jaci.2004.03.053. PMID: 15316499.
Phillips BG, Kato M, Narkiewicz K, Choe I, Somers VK. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol. 2000 Jul;279(1):H234-7. doi: 10.1152/ajpheart.2000.279.1.H234. PMID: 10899061.
Brunnée T, Graf K, Kastens B, Fleck E, Kunkel G. Bronchial hyperreactivity in patients with moderate pulmonary circulation overload. Chest. 1993 May;103(5):1477-81. doi: 10.1378/chest.103.5.1477. PMID: 8486030.
Asai K, Kanazawa H, Kamoi H, Shiraishi S, Hirata K, Yoshikawa J. Increased levels of vascular endothelial growth factor in induced sputum in asthmatic patients. Clin Exp Allergy. 2003 May;33(5):595-9. doi: 10.1046/j.1365-2222.2003.01576.x. PMID: 12752587.
Simcock DE, Kanabar V, Clarke GW, O'Connor BJ, Lee TH, Hirst SJ. Proangiogenic activity in bronchoalveolar lavage fluid from patients with asthma. Am J Respir Crit Care Med. 2007 Jul 15;176(2):146-53. doi: 10.1164/rccm.200701-042OC. Epub 2007 Apr 26. PMID: 17463417.
Schulz R, Hummel C, Heinemann S, Seeger W, Grimminger F. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med. 2002 Jan 1;165(1):67-70. doi: 10.1164/ajrccm.165.1.2101062. PMID: 11779732.
Carpagnano GE, Kharitonov SA, Resta O, Foschino-Barbaro MP, Gramiccioni E, Barnes PJ. Increased 8-isoprostane and interleukin-6 in breath condensate of obstructive sleep apnea patients. Chest. 2002 Oct;122(4):1162-7. doi: 10.1378/chest.122.4.1162. PMID: 12377837.
Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M, Christaki P, Bouros D. Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. Chest. 2007 Sep;132(3):843-51. doi: 10.1378/chest.07-0074. Epub 2007 Jun 15. PMID: 17573492.
Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, Erzurum S, Gaston BM, Wenzel SE, Jarjour NN; National Institutes of Health, National Heart, Lung and Blood Institute Severe Asthma Research Program (SARP) Investigators. Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II. J Allergy Clin Immunol Pract. 2015 Jul-Aug;3(4):566-75.e1. doi: 10.1016/j.jaip.2015.04.002. Epub 2015 May 21. PMID: 26004304; PMCID: PMC4500672.
Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, Erzurum S, Gaston BM, Wenzel SE, Jarjour NN; National Institutes of Health, National Heart, Lung and Blood Institute Severe Asthma Research Program (SARP) Investigators. Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II. J Allergy Clin Immunol Pract. 2015 Jul-Aug;3(4):566-75.e1. doi: 10.1016/j.jaip.2015.04.002. Epub 2015 May 21. PMID: 26004304; PMCID: PMC4500672.
Damianaki A, Vagiakis E, Sigala I, Pataka A, Rovina N, Vlachou A, Krietsepi V, Zakynthinos S, Katsaounou P. Τhe Co-Existence of Obstructive Sleep Apnea and Bronchial Asthma: Revelation of a New Asthma Phenotype? J Clin Med. 2019 Sep 16;8(9):1476. doi: 10.3390/jcm8091476. PMID: 31527545; PMCID: PMC6780801.
Sériès F, Roy N, Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994 Aug;150(2):481-5. doi: 10.1164/ajrccm.150.2.8049833. PMID: 8049833.
Henry Gong JR. Wheezing and Asthma. 3rd ed. Walker HK, Hall WD, Hurst JW, Henry Gong, JR. Boston: Butterworths; 1990.
Davies SE, Bishopp A, Wharton S, Turner AM, Mansur AH. The association between asthma and obstructive sleep apnea (OSA): A systematic review. J Asthma. 2019 Feb;56(2):118-129. doi: 10.1080/02770903.2018.1444049. Epub 2018 Apr 11. PMID: 29641292.
Chan CS, Woolcock AJ, Sullivan CE. Nocturnal asthma: role of snoring and obstructive sleep apnea. Am Rev Respir Dis. 1988 Jun;137(6):1502-4. doi: 10.1164/ajrccm/137.6.1502. PMID: 3059864.
Lafond C, Sériès F, Lemière C. Impact of CPAP on asthmatic patients with obstructive sleep apnoea. Eur Respir J. 2007 Feb;29(2):307-11. doi: 10.1183/09031936.00059706. Epub 2006 Oct 18. PMID: 17050561.
Kauppi P, Bachour P, Maasilta P, Bachour A. Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea. Sleep Breath. 2016 Dec;20(4):1217-1224. doi: 10.1007/s11325-016-1340-1. Epub 2016 Apr 7. PMID: 27055688.
Owens RL, Macrea MM, Teodorescu M. The overlaps of asthma or COPD with OSA: A focused review. Respirology. 2017 Aug;22(6):1073-1083. doi: 10.1111/resp.13107. Epub 2017 Jul 5. PMID: 28677827.
Serrano-Pariente J, Plaza V, Soriano JB, Mayos M, López-Viña A, Picado C, Vigil L; CPASMA Trial Group. Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea. Allergy. 2017 May;72(5):802-812. doi: 10.1111/all.13070. Epub 2016 Nov 3. PMID: 27732758; PMCID: PMC5412857.
Wang TY, Lo YL, Lin SM, Huang CD, Chung FT, Lin HC, Wang CH, Kuo HP. Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients. BMC Pulm Med. 2017 Mar 21;17(1):55. doi: 10.1186/s12890-017-0398-2. PMID: 28327130; PMCID: PMC5361857.