Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul-Aug;3(4):566-75.e1.
doi: 10.1016/j.jaip.2015.04.002. Epub 2015 May 21.

Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II

Mihaela Teodorescu  1 , Oleg Broytman  2 , Douglas Curran-Everett  3 , Ronald L Sorkness  4 , Gina Crisafi  4 , Eugene R Bleecker  5 , Serpil Erzurum  6 , Benjamin M Gaston  7 , Sally E Wenzel  8 , Nizar N Jarjour  4 ; National Institutes of Health, National Heart, Lung and Blood Institute Severe Asthma Research Program (SARP) Investigators
Affiliations

Obstructive Sleep Apnea Risk, Asthma Burden, and Lower Airway Inflammation in Adults in the Severe Asthma Research Program (SARP) II

Mihaela Teodorescu et al. J Allergy Clin Immunol Pract. 2015 Jul-Aug.

Abstract

Background: Obstructive sleep apnea (OSA) may worsen asthma, but large studies are lacking and the underlying mechanisms are unknown.

Objective: The objective of this study was to determine the prevalence of OSA risk among patients with asthma of different severity compared with normal controls (NC), and among asthmatics, to test the relationship of OSA risk with asthma burden and airway inflammation.

Methods: Subjects with severe (SA, n = 94) and nonsevere asthma (NSA, n = 161), and NC (n = 146) were recruited in an add-on substudy, to the observational Severe Asthma Research Program (SARP) II; subjects completed sleep quality, sleepiness and OSA risk (Sleep Apnea scale of the Sleep Disorders Questionnaire [SA-SDQ]) questionnaires, and clinical assessments. Sputum was induced in a subset of asthmatics.

Results: Relative to NC, despite similar sleep duration, the subjects with SA and NSA had worse sleep quality, were sleepier, and had higher SA-SDQ scores. Among asthmatics, higher SA-SDQ was associated with increased asthma symptoms, β-agonist use, health care utilization, and worse asthma quality of life. A significant association of SA-SDQ with sputum polymorphonuclear cells% was noted: each increase in SA-SDQ by its standard deviation (6.85 units) was associated with a rise in % sputum neutrophils of 7.78 (95% CI 2.33-13.22, P = .0006), independent of obesity and other confounders.

Conclusions: OSA symptoms are more prevalent among asthmatics, in whom they are associated with higher disease burden. OSA risk is associated with a neutrophilic airway inflammation in asthma, which suggests that OSA may be an important contributor to the neutrophilic asthma. Further studies are necessary to confirm these findings and better understand the mechanistic underpinnings of this relationship.

Keywords: Airway inflammation; Asthma; Obstructive; Sleep apnea.

PubMed Disclaimer

Conflict of interest statement

Mrs. Crisafi, Drs. Broytman, Curran-Everett, Sorkness, Bleecker, Erzurum, Gaston, Wenzel and Jarjour report no conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Sputum eosinophils and PMNs (expressed as percentage of sputum total white blood cell counts) in asthmatic subjects with and without high OSA risk (defined as scores on sleep apnea scale of the Sleep Disorders Questionnaire [SA-SDQ] ≥36 for men and ≥32 for women). In subjects with high OSA risk compared to those without high OSA, there were higher % PMNs, whereas % sputum eosinophils were similar between the two groups. *P-value=0.001 (two-sample Student t-test). Abbreviations: OSA=obstructive sleep apnea.
Figure 2
Figure 2
Proportion of sputum inflammatory phenotypes in asthmatic subjects with and without high OSA risk (defined as scores on sleep apnea scale of the Sleep Disorders Questionnaire [SA-SDQ] ≥36 for men and ≥32 for women). Asthmatic subjects with high OSA risk, compared to those without high OSA risk, tended to have higher proportions of neutrophilic and mixed granulocytic, and lower proportions of eosinophilic and paucigranulocytic phenotypes (p=0.06, Fisher's exact test). Abbreviations: OSA=obstructive sleep apnea.
See this image and copyright information in PMC

References

    1. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J. 2000;16:802–7. - PubMed
    1. Godard P, Chanez P, Siraudin L, Nicoloyannis N, Duru G. Costs of asthma are correlated with severity: a 1-yr prospective study. Eur Respir J. 2002;19:61–7. - PubMed
    1. Stempel DA, McLaughin TP, Stanford RH, Fuhlbrigge AL. Patterns of asthma control: a 3-year analysis of patient claims. J Allergy Clin Immunol. 2005;115:935–9. - PubMed
    1. Irwin RS, Curley FJ, French CL. Difficult-to-control asthma. Contributing factors and outcome of a systematic management protocol. Chest. 1993;103:1662–9. - PubMed
    1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased Prevalence of Sleep-Disordered Breathing in Adults. Am J Epidemiol. 2013 doi: 10.1093/aje/kws342. In Press. - DOI - PMC - PubMed

Publication types

MeSH terms