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[News] New Risk for Sleep Apnea: Asthma
Researchers Identify Potential New Risk for Sleep Apnea: Asthma

Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma.

Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin Sleep Cohort Study, which has been following approximately 1,500 people since 1988, researchers found that patients who had asthma were 1.70 times (95% CI=1.15-2.51) more likely to develop sleep apnea after eight years.

"This is the first longitudinal study to suggest a causal relationship between asthma and sleep apnea diagnosed in laboratory-based sleep studies," said Mihaela Teodorescu, MD, MS, assistant professor of medicine at the university, who presented the research at ATS 2013. "Cross-sectional studies have shown that OSA is more common among those with asthma, but those studies weren't designed to address the direction of the relationship."

The connection between asthma and OSA was even stronger among participants who developed asthma as children. Childhood-onset asthma was associated with 2.34 times (95% CI=1.25-4.37) the likelihood of developing sleep apnea.

The researchers also found that the duration of asthma affected the chances of developing sleep apnea. For every five-year increase in asthma duration, the chances of developing OSA after eight years increased by 10%. Participants in the Wisconsin Sleep Cohort, who were all between the ages of 30 and 60 in 1988, complete in-laboratory polysomnography, clinical assessments, and health history questionnaires every four years. For the asthma-OSA study, the researchers focused on 773 cohort enrollees who did not have OSA (apnea-hypopnea index <5) when they joined the study and then determined whether their sleep apnea status had changed after eight years.

The study adjusted for variables known to contribute to sleep apnea, including age, sex, body mass index (BMI), smoking, number of alcoholic drinks per week, and nasal congestion. The study also took into account changes in BMI and the addition of new asthma cases.

During the eight-year follow-up period, 45 subjects developed asthma, and they were 48% more likely to develop new-onset sleep apnea. However, because the sample size was small, the increase lacked statistical significance.

"Forty-eight percent represents a large difference," said Paul Peppard, PhD, assistant professor of population health sciences at the university and a principal investigator of the Wisconsin Sleep Cohort Study. "This is one result that calls for a follow-up study. If confirmed by a larger study with more asthma cases, the finding would have important clinical relevance."

He added, "For now, it makes sense for clinicians to consider asthma history, as well as more traditional factors associated with OSA such as obesity, when deciding whether to evaluate patients for OSA with a sleep study."

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It is not uncommon for CPAP users to develop a mild form of asthma, however it is neither harmful nor worrisome, just inconvenient and occasionally uncomfortable.
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(08-05-2013, 04:49 PM)DocWils Wrote: It is not uncommon for CPAP users to develop a mild form of asthma, however it is neither harmful nor worrisome, just inconvenient and occasionally uncomfortable.

Does anyone have more information about this? My interest is piqued.

BTW, how do you differentiate asthma from other lung-related things like COPD or emphysema?
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(08-05-2013, 03:52 PM)ApneaNews Wrote: Researchers Identify Potential New Risk for Sleep Apnea: Asthma

Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma.

Unless I'm reading this wrong - if you have asthma, you have a greater risk of sleep apnea, not the other way around.
Seems like the headline got it backwards and the article keeps going one way or the other.
Just saying...

Honolulu, HI
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Perhaps asthma is the wrong term here - actually we say "asthma like symptoms" and then a scale rating, where it falls under "mild asthma". It is well supported in the literature - mostly it just means you may start getting more of a cough than before and some feeling of breathlessness or discomfort at the top and bottom of a breath, in this case - the culprit is the constant humid pressure forced into the lungs along with an increased volume of mucous naturally inhaled to the lungs due to the "push" of the pressure. Not everyone suffers from it, and those who do not use humidifiers suffer less from it (but this does not mean bin the humidifier - you need it in many locales, and if you have a sore throat in the morning without it, you definitely need it). There is no reason to be alarmed by this - it has been reported often by CPAP patients and follow up exams show no actual danger or lasting harm. There is no danger of needing an inhalator to deal with it, as the problem does not significantly relate to air flow restriction and more to a comfort factor. It is also seen as a knock on effect from other forms of forced air therapies and is well documented in those cases.

If you already have asthma, there is some evidence that you may also suffer from apnoea as well, and this article certainly details that. So far only small sample groups have existed, and i know of two more studies being launched, so again, early days. On the whole, if you have one breathing ailment it seems to have knock on effects that can raise other ailments or shadow symptoms.

We distinguish between lung ailments with testing and symptom analysis. No rocket science involved. Most of the tests are relatively simple with only a few requiring big expensive machines with leads and flashy lighty thingys. You'd be surprised what you can pick up with a visual observation, a blood test, a good ear and blowing into a cardboard tube with a simple meter on the end of it. X-rays are also quite useful.

In terms of what they are, well, they are light years apart in some ways, the common factor being the air intake and flush is affected. I won't bore you with a detailed explanation of each of the diseases.
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Here's what I think is going on.

Quote:researchers found that patients who had asthma were 1.70 times (95% CI=1.15-2.51) more likely to develop sleep apnea after eight years.

This should instead read:

researchers found that patients who had asthma were 1.70 times (95% CI=1.15-2.51) more likely to be diagnosed with sleep apnea after eight years.

People who have been diagnosed with asthma are going to be far more likely to find themselves in the offices of doctors who treat patients with asthma. These same doctors are treating other patients for other breathing disorders such as sleep apnea. These asthma patients are therefore more likely than folks in the general population to be tested for sleep apnea.

Understanding and interpreting these medical research results is tricky business. We should always ask for, and pay close attention to, the facts that were used by the researchers to draw their conclusions. The facts themselves can also be called into question, but it is far more likely that the conclusions drawn from the facts are at least in part erroneous.
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I don't see that the study demonstrates the Asthma causes OSA.

It could equally demonstrate that there is some other common factor....

Like perhaps the effect that relatively high doses of the steroidal preventers have on the body of developing children and adolescents.

The headline is odd but correctly reports the study... According to the study having asthma - especially as a child - is a risk indicator for OSA.

That said - the study is reported as 'suggesting' causality - it does not find actual causality. It reports only a statistical link.
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Hmm: I developed allergies during my high school years (mid-60s); chronic asthma in the mid-70s and sleep apnea in the mid-90s. While I understand the link between allergies and asthma, the link between asthma and OSA is less clear to me. The sleep docs always said my weight was the cause of the apnea.
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