CLINICAL AND FUNCTIONAL PECULIARITIES OF COMORBID OBSTRUCTIVE SLEEP APNEA SYNDROME AND ASTHMA

Obstructive sleep apnea syndrome (OSAS) is a pathogenetically heterogeneous condition that aggravates the course of asthma. For this reason, timely diagnosis and treatment of OSAS may improve asthma control, reduce the number of exacerbations and the frequency of short-acting bronchodilators use. The aim of the study was to describe the clinical and functional features of patients with asthma and OSAS, and to identify risk factors that allow suspecting the comorbidity. A total of 194 patients with asthma were examined. The research methods included assessment of symptoms using the ACT questionnaire, spirometry with bronchoprovocational tests, body plethysmography and determination of lung diffusion capacity, analysis of the cellular composition of induced sputum, echocardiography, overnight cardiorespiratory monitoring. According to the results of cardio-respiratory monitoring OSAS of varying severity was detected in 33% of patients (n=65). Epworth sleepiness scale did not allow specific discrimination of OSAS among the examined patients. In general, patients with the comorbid pathologies were more often men of older age groups, they had a long history of disease and smoking. In patients with OSAS diabetes and cardiovascular diseases were more common in the structure of concomitant pathology. The presence of OSAS did not significantly affect spirometry but was associated with a pronounced airway hyperresponsiveness regardless of the provocative stimulus. In addition, a higher airway resistance and an increase in lung diffusion capacity were noted in OSAS patients. Neutrophilic phenotype of inflammation was three times more common in case of concomitant OSAS, and signs of cardiac remodeling and an increase in pulmonary artery pressure were also observed in these patients. Thus, knowledge of the above features of asthma-OSAS phenotype will facilitate timely diagnosis and optimal therapeutic care for patients with a combination of pathologies.

obstructive sleep apnea syndrome, asthma, phenotype, lung function, airway hyperresponsiveness

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27. Irwin R.S., Curley F.J., French C.L. Difficult-to-control asthma. Contributing factors and outcome of a systematic management protocol. Chest 1993; 103(6):1662-1669.

28. Kashyap L., Hock L. M., Bowman T. J. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep and Breath 2001; 5(4):167-172. doi:10.1007/s11325-001-0167-5

29. Kim K.S., Kim J.H., Park S.Y., Won H.R., Lee H.J., Yang H.S., Kim H.J. Smoking induces oropharyngeal narrowing and increases the severity of obstructive sleep apnea syndrome. J. Clin. Sleep. Med. 2012; 8(4):367-374. doi: 10.5664/jcsm.2024

30. Knuiman M., James A., Divitini M. Bartholomew H. Longitudinal study of risk factors for habitual snoring in a general adult population: The Busselton Health Study. Chest 2006; 130(6):1779-1783. doi:10.1378/chest.130.6.1779

31. Leuppi J.D., Salome C.M., Jenkins C.R., Anderson S.D., Xuan W., Marks G.B., Koskela H., Brannan J.D., Freed R., Andersson M., Chan H.K., Woolcock A.J. Predictive markers of asthma exacerbation during stepwise dose reduction of inhaled corticosteroids. Am. J. Respir. Crit. Care Med. 2001; 163(2):406-412. doi: 10.1164/ajrccm.163.2.9912091

32. Marrone O., Bonsignore M.R. Pulmonary haemodynamics in obstructive sleep apnoea. Sleep Med. Rev. 2002; 6(3):175-193.

33. Nadel J.A., Widdicombe J.G. Reflex effects of upper airway irritation on total lung resistance and blood pressure. J. Appl. Physiol. 1962; 17:861-865. doi: 10.1152/jappl.1962.17.6.861

34. Peat J. K., Woolcock A. J., Cullen K. Rate of decline of lung function in subjects with asthma. Eur. J. Respir. Dis. 1987; 70(3):171-179.

35. Peppard P.E., Young T., Palta M., Dempsey J., Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284(23):3015-3021.

36. Stempel D.A., McLaughin T.P., Stanford R.H., Fuhlbrigge A.L. Patterns of asthma control: a 3-year analysis of patient claims. J. Allergy. Clin. Immunol. 2005; 115(5):935-939. doi: 10.1016/j.jaci.2005.01.054

37. Teodorescu M., Broytman O., Curran-Everett D., Sorkness R.L., Crisafi G., Bleecker E.R., Erzurum S., Gaston B.M., Wenzel S.E., Jarjour N.N., National Institutes of Health, National Heart, Lung and Blood Institute Severe Asthma Research Program (SARP) Investigators. Obstructive sleep apnea risk, asthma burden, and lower airway inflammation in adults in the severe asthma research program (SARP) II. J. Allergy Clin. Immunol. Pract. 2015; 3(4):566-575. doi: 10.1016/j.jaip.2015.04.002

38. Teodorescu M., Polomis D.A., Gangnon R.E., Fedie J.E., Consens F.B., Chervin R.D., Teodorescu M.C. Asthma control and its relationship with obstructive sleep apnea (OSA) in older adults. Sleep Disord. 2013; 2013:251567. doi: 10.1155/2013/251567

39. Teodorescu M., Xie A., Sorkness C.A., Robbins J., Reeder S., Gong Y., Fedie J.E., Sexton A., Miller B., Huard T., Hind J., Bioty N., Peterson E., Kunselman S.J., Chinchilli V.M., Soler X., Ramsdell J., Loredo J., Israel E., Eckert D.J., Malhotra A. Effects of inhaled fluticasone on upper airway during sleep and wakefulness in asthma: a pilot study. J.Clin. Sleep Med. 2014; 10(2):183-193. doi: 10.5664/jcsm.3450

40. White D.P., Douglas N.J., Pickett C.K., Weil J.V., Zwillich C.W. Sexual influence on the control of breathing. J. Appl. Physiol. 1983; 54(4):874-879. doi: 10.1152/jappl.1983.54.4.874