The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 371-376, August 2009

Prevalence of obstructive sleep apnea–hypopnea in severe versus moderate asthma

  • Joanne Y. Julien, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • ,
  • James G. Martin, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • ,
  • Pierre Ernst, MD

      Affiliations

    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • ,
  • Ronald Olivenstein, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • ,
  • Qutayba Hamid, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • ,
  • Catherine Lemière, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Département de Pneumologie, Hôpital Sacre-Coeur, Université de Montréal, Montreal, Quebec, Canada
    • ,
  • Carmela Pepe, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • ,
  • Naftaly Naor, MSc

      Affiliations

    • Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
    • ,
  • Allen Olha, MSc

      Affiliations

    • Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
    • ,
  • R. John Kimoff, MD

      Affiliations

    • Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
    • Respiratory Division, McGill University, Montreal, Quebec, Canada
    • Sleep Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
    • Corresponding Author InformationReprint requests: R. John Kimoff, MD, Respiratory Division, Room L4.08, McGill University Health Centre, 687 Pine Ave W, Montreal, Quebec, Canada, H3A 1A1.

Received 25 November 2008; received in revised form 9 May 2009; accepted 13 May 2009. published online 29 June 2009.

Background

Previous studies have suggested a link between obstructive sleep apnea and poor asthma control, which may be mediated through airway inflammation, obesity, and other mechanisms.

Objective

To test the hypothesis that the prevalence and severity of sleep apnea is greater among patients with severe compared with moderate asthma and controls without asthma.

Methods

Complete overnight home polysomnography was performed in 26 patients with severe asthma consecutively recruited to a difficult asthma program, 26 patients with moderate asthma, and 26 controls without asthma of similar age and body mass index. Flow rates and Juniper asthma control and quality of life questionnaires were also obtained.

Results

Obstructive sleep apnea–hypopnea, defined by an Apnea–Hypopnea Index ≥15 events/h of sleep scored using Chicago criteria, was present in 23 of 26 (88%) patients with severe asthma, 15 of 26 (58%) patients with moderate asthma, and 8 of 26 (31%) controls without asthma (χ2: P < .001). Using the more restrictive scoring criteria applied in the Wisconsin cohort study, Apnea-Hypopnea Index ≥5/h was present in 50% (severe), 23% (moderate), and 12% (control) of subjects (P = .007). Mean nocturnal arterial oxygen saturation was significantly lower in patients with severe asthma versus controls, and apnea-hypopnea severity measures were significantly worse for both asthmatic groups compared with controls. Among subjects with asthma, no significant correlations were identified between the severity of sleep-disordered breathing and asthma severity or control measures (FEV1, Juniper scores).

Conclusions

Obstructive sleep apnea–hypopnea was significantly more prevalent among patients with severe compared with moderate asthma, and more prevalent for both asthma groups than controls without asthma. These observations suggest potential pathophysiologic interactions between obstructive sleep apnea–hypopnea and asthma severity and control.

Key words: Sleep, sleep apnea, obstructive, dyspnea, paroxysmal, asthma

Abbreviations used: AHI, Apnea-Hypopnea Index, BMI, Body mass index, OSAH, Obstructive sleep apnea–hypopnea, SaO2, Arterial oxygen saturation, TST, Total sleep time

 

 Supported by grants from the Richard and Edith Strauss Canada Foundation, McGill University Health Centre Research Institute, and the Fonds de la Recherche en Santé du Québec. J.Y.J. was a recipient of the Ann Woolcock Memorial Fellowship, was supported by GlaxoSmithKline Canada Inc, and is a CHEST Foundation Awardee. R.J.K. was a Clinical Research Scholar of the Fonds de la Recherche en Santé du Québec. Q.H. is a recipient of a Chercheur Nationale award from the Fonds de la Recherche en Santé du Québec.

 Disclosure of potential conflict of interest: P. Ernst is on the advisory board and speakers' bureau for AstraZeneca, GlaxoSmithKline, Merck, Novartis, Nycomed, and Pfizer and receives grant support from the Canadian Institutes of Health Research. R. Olivenstein receives grant support from Novartis and Asthmatx. Catherine Lemière receives grant support from the National Institute for Occupational Safety and Health and the Institut de Recherche Robert-Sauvé en Santé et en Securité du Travail. R. J. Kimoff receives speaker fees from GlaxoSmithKline and VitalAire Inc and receives grant support from the Fonds de la Recherche en Santé du Québec and the Multiple Sclerosis Society of Canada. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00808-2

doi:10.1016/j.jaci.2009.05.016

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 371-376, August 2009

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