Association of Obstructive Sleep Apnea Risk or Diagnosis with Daytime Asthma in Adults

Abstract

Objective. Obstructive sleep apnea (OSA) worsens nocturnal asthma, but its potential impact on daytime asthma remains largely unassessed. We investigated whether the sleep disorder is associated with daytime, in addition to nighttime, asthma symptoms. Methods. Asthma patients at tertiary-care centers completed the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ), and an asthma control questionnaire. SA-SDQ scores ≥36 for males and ≥32 for females defined high OSA risk. Medical records were reviewed for established diagnosis of OSA and continuous positive airway pressure (CPAP) use. Results. Among 752 asthma patients, high OSA risk was associated similarly with persistent daytime and nighttime asthma symptoms (p < .0001 for each). A diagnosis of OSA was robustly associated with persistent daytime (p < .0001) in addition to nighttime (p = .0008) asthma symptoms. In regression models that included obesity and other known asthma aggravators, high OSA risk retained associations with persistent daytime (odds ratio [OR] = 1.96 [95% confidence interval [CI] = 1.31–2.94]) and nighttime (1.97 [1.32–2.94]) asthma symptoms. Diagnosed OSA retained an association with persistent daytime (2.08 [1.13–3.82]) but not with nighttime (1.48 [0.82–2.69]) asthma symptoms. CPAP use was associated with lower likelihood of persistent daytime symptoms (0.46 [0.23–0.94]). Conclusions. Questionnaire-defined OSA risk and historical diagnosis were each associated with persistent daytime asthma symptoms, to an extent that matched or exceeded associations with nighttime asthma symptoms. Unrecognized OSA may be a reason for persistent asthma symptoms during the day as well as the night.

• asthma
• asthma control
• obstructive sleep apnea
• obstructive sleep apnea risk
• sleep

Acknowledgments

Author Contributions:

Conception and design: M. Teodorescu and D.A. Polomis

Data collection: M. Teodorescu, D.A. Polomis, M.C. Teodorescu, and A.G. Peterson

Data analysis: M. Teodorescu and R.E. Gangnon

Interpretation of the data: M. Teodorescu, D.A. Polomis, R.E. Gangnon, R.D. Chervin, F.B. Consens, M.C. Teodorescu, A.G. Peterson, and N.N. Jarjour

Drafting of the article: M. Teodorescu and D.A. Polomis

Critical revision of the article for important intellectual content: D.A. Polomis, R.D. Chervin, R.E. Gangnon, M.C. Teodorescu, F.B. Consens, and N.N. Jarjour

The authors are grateful to the study subjects for their participation. They are also grateful to Carolyn M. Senger, B.S.; Ashley S. Holland, M.P.H.; Radu C. Nistor; Jesica M. Pedroza, B.S.; Stephanie V. Hall, B.S.; Whitney Stalsberg, B.S.; Roman Aydiko, B.S.; and Padau Yang, B.S., for assistance with administration of screening questionnaires in clinics and data entry. We recognize the help from the providers and staff at the Pulmonary Clinics and Briarwood Asthma-Airways Center at the University of Michigan—Ann Arbor, and Allergy and Pulmonary Clinics at the University of Wisconsin—Madison in recruiting subjects for this study.

Funding support: Received funding support from the National Institutes of Health (nos. T32 NS007222, MO1 RR00042, and 1UL1RR025011); the University of Wisconsin School of Medicine and Public Health, Medical Education and Research Committee—New Investigator Award; and the University of Wisconsin School of Medicine and Public Health Department of Medicine. Additional resources from the William S. Middleton Memorial Veteran’s Hospital, Madison, Wisconsin.

Declaration of Interest

Funding support for this study was from the University of Michigan Department of Neurology Training Grant (T32 NS007222) and General Clinical Research Center (MO1 RR00042); the University of Wisconsin School of Medicine and Public Health, Medical Education and Research Committee—New Investigator Award, Department of Medicine, and 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health; and the William S. Middleton Memorial Veteran’s Hospital, Madison, Wisconsin.

Dr Mihaela Teodorescu received funding support from the University of Michigan Department of Neurology Training Grant (T32 NS007222) and General Clinical Research Center (MO1 RR00042); University of Wisconsin School of Medicine and Public Health, Department of Medicine and Medical Education and Research Committee—New Investigator Award, and 1UL1RR025011 from the CTSA program of the National Center for Research Resources, National Institutes of Health for asthma-sleep apnea research. She received additional support from and uses facilities at the William S. Middleton Memorial Veteran’s Hospital, Madison, Wisconsin.

Drs D.A. Polomis, M.C. Teodorescu, R.E. Gangnon, F.B. Consens, and Ms A.G. Peterson have no relationships to disclose.

Dr R.D. Chervin has received research support from the National Institutes of Health and Fox Foundation and has served on the advisory boards for Pavad Medical, not-for-profit Sweet Dreamzzz, and the NHLBI (Sleep Disorders Research Advisory Board). Chervin is a section editor for UpToDate, Inc.; received support for educational purposes from Philips Respironics, Inc. and Fisher Paykel, Inc.; and has consulted for Arena Pharmaceuticals, Proctor & Gamble, and Zansors. Chervin serves on the Board of Directors of the American Academy of Sleep Medicine and the International Pediatric Sleep Association and is named in University of Michigan patents for algorithms and devices to facilitate diagnosis and treatment of sleep disorders.

Dr N.N. Jarjour received funding support from the National Institutes of Health, GlaxoSmithKline (GSK), and Bristol Meyer Squib, and received honorarium <$5000 from the Saudi Thoracic Society for a GSK-supported continuing medical education program.

No scientific writing assistance was used for this article. The contents of this article do not represent the views of the Department of Veteran’s Affairs or the US Government.