Teodorescu Mihaela, Polomis David A, Teodorescu Mihai C, Gangnon Ronald E, Peterson Andrea G, Consens Flavia B, Chervin Ronald D, Jarjour Nizar N
Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA.
J Asthma. 2012 Aug;49(6):620-8. doi: 10.3109/02770903.2012.689408. Epub 2012 Jun 28.
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.
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.
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]).
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.
阻塞性睡眠呼吸暂停（OSA）会加重夜间哮喘，但它对白天哮喘的潜在影响在很大程度上仍未得到评估。我们调查了这种睡眠障碍是否除了与夜间哮喘症状相关外，还与白天哮喘症状有关。
三级医疗中心的哮喘患者完成了睡眠障碍问卷的睡眠呼吸暂停量表（SA-SDQ）以及一份哮喘控制问卷。男性SA-SDQ评分≥36分且女性≥32分定义为高OSA风险。查阅病历以确定OSA的确诊情况和持续气道正压通气（CPAP）的使用情况。
在752名哮喘患者中，高OSA风险与持续的白天和夜间哮喘症状的关联相似（每项p < .0001）。OSA的诊断与持续的白天（p < .0001）以及夜间（p = .0008）哮喘症状密切相关。在纳入肥胖和其他已知哮喘加重因素的回归模型中，高OSA风险与持续的白天（优势比[OR] = 1.96 [95%置信区间[CI] = 1.31 - 2.94]）和夜间（1.97 [1.32 - 2.94]）哮喘症状仍有关联。确诊的OSA与持续的白天（2.08 [1.13 - 3.82]）哮喘症状有关，但与夜间（1.48 [0.82 - 2.69]）哮喘症状无关。使用CPAP与持续白天症状的可能性较低相关（0.46 [0.23 - 0.94]）。
问卷定义的OSA风险和既往诊断均与持续的白天哮喘症状相关，其程度与夜间哮喘症状的关联相当或更高。未被识别的OSA可能是白天和夜间哮喘症状持续存在的一个原因。
