Pulmonology Department, University Hospital of Cattinara, Strada di Fiume 447, Trieste, Italy.
Pulmonology Department, Bellaria Hospital, Bologna, Italy.
Sleep Breath. 2023 Jun;27(3):933-941. doi: 10.1007/s11325-022-02665-4. Epub 2022 Jul 30.
Obstructive sleep apnea syndrome (OSAS) and asthma are two diseases with a high epidemiological impact that may often coexist. Both diseases have underlying pathogenic mechanisms (chronic inflammation, genetic predisposition, etc.); it is still unclear whether or not their coexistence is due to a specific pathophysiological factor. In the literature, the pathogenesis of OSAS has four pathophysiological traits: one or more anatomical predisposing factors, a low arousal threshold (low AT), high loop gain, and poor muscle responsiveness. In this study, we hypothesized that a low AT is a common pathophysiological factor in OSAS and asthma.
A retrospective study of patients attending the Pulmonology Unit of the University Hospital of Trieste was carried out. Low AT was predicted on the bases of the following polysomnography features, as previously shown by Edwards et al.: an AHI of < 30 events/h, a nadir SpO2 of > 82.5%, and a hypopnea fraction of total respiratory events of > 58.3%.
Thirty-five patients with asthma and OSAS and 36 with OSAS alone were included in the study. Low AT was present in 71% of patients affected by asthma and OSAS (25 patients out of 35) versus 31% (11 patients out of 36) of patients affected by OSAS alone with a statistically significant difference (p = 0.002) between the two groups. Stratifying for BMI and OSAS severity, the difference between groups remained statistically significant.
This is the first study to describe specific polysomnographic characteristics of patients affected by asthma and OSAS. A low AT may well be the pathophysiological factor common to the two diseases. If confirmed by other studies, this finding could lead to the presence of asthma and OSAS in the same individual being considered a syndrome with a common pathophysiological factor.
阻塞性睡眠呼吸暂停综合征（OSAS）和哮喘是两种具有高流行病学影响的疾病，它们常常同时存在。这两种疾病都有潜在的发病机制（慢性炎症、遗传易感性等）；它们的共存是否归因于特定的病理生理因素仍不清楚。在文献中，OSAS 的发病机制有四个病理生理特征：一个或多个解剖学易患因素、低觉醒阈值（低 AT）、高环路增益和肌肉反应性差。在本研究中，我们假设低 AT 是 OSAS 和哮喘的共同病理生理因素。
对的里雅斯特大学医院呼吸科的患者进行了回顾性研究。如 Edwards 等人先前所示，低 AT 是根据以下多导睡眠图特征预测的：每小时呼吸暂停低通气指数（AHI）<30 次、最低血氧饱和度（SpO2）>82.5%和呼吸暂停低通气指数占总呼吸事件的 58.3%以上。
研究纳入了 35 例哮喘合并 OSAS 患者和 36 例单纯 OSAS 患者。在哮喘合并 OSAS 的患者中，低 AT 发生率为 71%（25 例），而单纯 OSAS 患者为 31%（11 例），两组之间有统计学显著差异（p=0.002）。按 BMI 和 OSAS 严重程度分层，两组之间的差异仍具有统计学意义。
这是第一个描述哮喘合并 OSAS 患者特定多导睡眠图特征的研究。低 AT 很可能是这两种疾病的共同病理生理因素。如果其他研究也能证实这一发现，那么在同一患者中同时存在哮喘和 OSAS 可能被认为是一种具有共同病理生理因素的综合征。
