Tondo Pasquale, Fanfulla Francesco
Respiratory Medicine Unit, Department of Medical and Surgical Sciences, University of Foggia.
Respiratory Function and Sleep Medicine Unit, ICS Maugeri IRCCS, Pavia, Italy.
Multidiscip Respir Med. 2022 Oct 4;17(1):853. doi: 10.4081/mrm.2022.853. eCollection 2022 Jan 12.
The relationship between asthma and obstructive sleep apnea (OSA) is a widely debated topic in the scientific literature with the controversy surrounding the bi-directional nature of the correlation.
We report the case of a 59-year-old male being affected by severe allergic eosinophilic asthma and severe OSA (apnea-hypopnea index [AHI] 32 ev·hr). Due to a clinical worsening of asthma (aggravation of dyspnea, chest constriction and night-time respiratory symptoms), despite the optimal therapy for asthma and recurrent administration of systemic corticosteroids, we have added-on treatment with benralizumab (monoclonal anti-interleukin 5 antibody). After eight months, the patient reported an improvement in asthma control (asthma control test [ACT]= 25 points), in pulmonary function and a good control of nocturnal symptoms of both diseases ., wheezing, snoring, etc.). Then, the follow up polysomnography (PSG) was performed resulting in a high reduction of OSA severity (~18% AHI) even if obstructive events persisted and almost resolution of nocturnal hypoxemia. So, a trial with positive airway pressure (PAP) was proposed to the patient, who declined.
In consideration of our experience, we suggest that the nocturnal profile of patients with severe asthma should be always studied by a sleep investigation to prevent the negative effects of interaction with OSA. However, further studies on larger samples are needed to better understand the pathophysiological mechanisms underlying the beneficial effects of benralizumab on obstructive events during sleep.
哮喘与阻塞性睡眠呼吸暂停（OSA）之间的关系是科学文献中一个广泛争论的话题，围绕着这种相关性的双向性质存在争议。
我们报告一例59岁男性，患有严重过敏性嗜酸性粒细胞性哮喘和严重OSA（呼吸暂停低通气指数[AHI]为32次/小时）。尽管对哮喘进行了最佳治疗并反复给予全身用糖皮质激素，但由于哮喘临床症状恶化（呼吸困难、胸部紧缩感和夜间呼吸道症状加重），我们加用了贝那利珠单抗（抗白细胞介素5单克隆抗体）进行治疗。八个月后，患者报告哮喘控制情况改善（哮喘控制测试[ACT]=25分），肺功能改善，两种疾病的夜间症状得到良好控制（如喘息、打鼾等）。然后进行了随访多导睡眠图（PSG）检查，结果显示OSA严重程度大幅降低（AHI约降低18%），尽管阻塞性事件仍然存在，夜间低氧血症几乎得到缓解。因此，向患者提出了气道正压通气（PAP）试验，但患者拒绝了。
考虑到我们的经验，我们建议对于重度哮喘患者，应始终通过睡眠调查研究其夜间情况，以预防与OSA相互作用产生的负面影响。然而，需要对更大样本进行进一步研究，以更好地理解贝那利珠单抗对睡眠期间阻塞性事件有益作用的病理生理机制。
