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. 2023 Jun;27(3):933-941.
doi: 10.1007/s11325-022-02665-4. Epub 2022 Jul 30.

Low arousal threshold: a common pathophysiological trait in patients with obstructive sleep apnea syndrome and asthma

Caterina Antonaglia  1 , Giovanna Passuti  2 , Fabiola Giudici  3 , Francesco Salton  4 , Barbara Ruaro  4 , Dejan Radovanovic  5 , Marco Confalonieri  4
Affiliations

Low arousal threshold: a common pathophysiological trait in patients with obstructive sleep apnea syndrome and asthma

Caterina Antonaglia et al. Sleep Breath. 2023 Jun.

Abstract

Introduction: Obstructive sleep apnea syndrome (OSAS) and asthma are two diseases with a high epidemiological impact that may often coexist. Both diseases have underlying pathogenic mechanisms (chronic inflammation, genetic predisposition, etc.); it is still unclear whether or not their coexistence is due to a specific pathophysiological factor. In the literature, the pathogenesis of OSAS has four pathophysiological traits: one or more anatomical predisposing factors, a low arousal threshold (low AT), high loop gain, and poor muscle responsiveness. In this study, we hypothesized that a low AT is a common pathophysiological factor in OSAS and asthma.

Methods: A retrospective study of patients attending the Pulmonology Unit of the University Hospital of Trieste was carried out. Low AT was predicted on the bases of the following polysomnography features, as previously shown by Edwards et al.: an AHI of < 30 events/h, a nadir SpO2 of > 82.5%, and a hypopnea fraction of total respiratory events of > 58.3%.

Results: Thirty-five patients with asthma and OSAS and 36 with OSAS alone were included in the study. Low AT was present in 71% of patients affected by asthma and OSAS (25 patients out of 35) versus 31% (11 patients out of 36) of patients affected by OSAS alone with a statistically significant difference (p = 0.002) between the two groups. Stratifying for BMI and OSAS severity, the difference between groups remained statistically significant.

Conclusions: This is the first study to describe specific polysomnographic characteristics of patients affected by asthma and OSAS. A low AT may well be the pathophysiological factor common to the two diseases. If confirmed by other studies, this finding could lead to the presence of asthma and OSAS in the same individual being considered a syndrome with a common pathophysiological factor.

Keywords: Alternative overlap syndrome; Asthma and OSA; Obstructive sleep apnea; aLow arousal threshold.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
AHI distribution
Fig. 2
Fig. 2
BMI distribution
Fig. 3
Fig. 3
Correlation between AHI and BMI in group 1
Fig. 4
Fig. 4
Correlation between AHI and BMI in group 2
Fig. 5
Fig. 5
Low AT and severity of OSA
See this image and copyright information in PMC

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