Davies Sarah E, Bishopp Abigail, Wharton Simon, Turner Alice M, Mansur Adel H
a Birmingham Regional Severe Asthma Service, Heart of England NHS Trust, Institute of Inflammation and Ageing , University of Birmingham , Birmingham , UK.
b Birmingham Heartlands Sleep Service , Heart of England NHS Trust , Birmingham , UK.
J Asthma. 2019 Feb;56(2):118-129. doi: 10.1080/02770903.2018.1444049. Epub 2018 Apr 11.
Bronchial asthma and obstructive sleep apnoea (OSA) are common respiratory disorders that can co-exist. The strength of this association, and also the impact of OSA on asthma-related clinical outcomes remain unclear.
Literature review was performed in EMBASE and MEDLINE databases. Studies up to and including 2016 were selected.
Studies were included if they contained; 1) a population with asthma AND 2) a prevalence of OSA reported using either polysomnography or validated questionnaires such as the Sleep Apnoea Scale of the Sleep Disorders Questionnaire (SA-SDQ), STOP BANG or the Berlin questionnaire.
Nineteen studies were identified. Thirteen questionnaire-based studies met the inclusion/exclusion criteria and twelve of these demonstrated a prevalence of OSA in asthma of 8-52.6%, with one study showing no association between the two conditions. Six studies using polysomnography demonstrated a high prevalence of 19.2-60%; which was higher at 50-95% in severe asthma. Two polysomnography and four questionnaire studies found worse asthma-related clinical outcomes with co-existing OSA. One polysomnography and two questionnaire studies showed no difference.
This systematic review suggests that there is a high prevalence of OSA in asthma, particularly within severe asthma populations and that co-diagnosis of OSA in asthma patients is associated with worse clinical outcomes. However this outcome was not uniform and the number of studies using polysomnography to confirm OSA was small. This weakens the conclusions that can be drawn and prompts the need for adequately powered and well-designed studies to confirm or refute these findings.
支气管哮喘和阻塞性睡眠呼吸暂停（OSA）是常见的可同时存在的呼吸系统疾病。这种关联的强度以及OSA对哮喘相关临床结局的影响仍不明确。
在EMBASE和MEDLINE数据库中进行文献综述。选取截至2016年（含2016年）的研究。
符合以下条件的研究纳入其中：1）有哮喘患者群体；2）报告了使用多导睡眠图或经过验证的问卷（如睡眠障碍问卷的睡眠呼吸暂停量表（SA-SDQ）、STOP BANG或柏林问卷）得出的OSA患病率。
共确定了19项研究。13项基于问卷的研究符合纳入/排除标准，其中12项显示哮喘患者中OSA的患病率为8%-52.6%，有1项研究表明这两种疾病之间无关联。6项使用多导睡眠图的研究显示患病率较高，为19.2%-60%；在重度哮喘患者中更高，为50%-95%。两项多导睡眠图研究和四项问卷研究发现，并存OSA时哮喘相关临床结局更差。一项多导睡眠图研究和两项问卷研究显示无差异。
这项系统评价表明，哮喘患者中OSA的患病率较高，尤其是在重度哮喘人群中，哮喘患者并存OSA与更差的临床结局相关。然而，这一结果并不一致，且使用多导睡眠图确诊OSA的研究数量较少。这削弱了所得出结论的可信度，并促使需要开展有足够样本量和精心设计的研究来证实或反驳这些发现。
