Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China.
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China.
Eur J Med Res. 2023 Mar 30;28(1):139. doi: 10.1186/s40001-023-01097-4.
There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa.
We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis.
34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64).
OSA was associated with more severe or difficult-to-control asthma with decreased %FEV in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.
阻塞性睡眠呼吸暂停（OSA）的患病率与哮喘之间存在密切关联。然而，OSA 是否会影响哮喘患者的肺功能、症状和控制，以及哮喘是否会增加 OSA 中的呼吸事件尚不清楚。本荟萃分析旨在研究 OSA 与哮喘严重程度之间的关系及其相互影响。
我们从建库到 2022 年 9 月对 PubMed、EMBASE 和 Scopus 进行了系统检索。主要结局为肺功能、多导睡眠图参数、严重或难以控制的哮喘患者中 OSA 的风险，以及严重 OSA 患者中哮喘的风险。采用 Q 检验和 I 统计量评估异质性。我们还进行了亚组分析、Meta 回归和 Egger 检验进行偏倚分析。
共纳入 34 项研究，总计 27912 名受试者。结果表明，OSA 合并症使哮喘患者的肺功能恶化，导致一秒用力呼气容积占预计值的百分比（%FEV1）降低，这一效应在儿童中更为明显。成人哮喘患者合并 OSA 时，%FEV1 有下降趋势，但无统计学意义。有趣的是，严重 OSA 患者的哮喘风险似乎略低（OR=0.87，95%CI 0.763-0.998）。哮喘对多导睡眠图无显著影响，但增加了 OSA 患者的 Epworth 嗜睡量表评估的日间嗜睡（WMD=0.60，95%CI 0.16-1.04）。更严重的哮喘或难以控制的哮喘与 OSA 独立相关（比值比（OR）=4.36，95%CI 2.49-7.64）。
OSA 与儿童哮喘患者中更严重或难以控制的哮喘有关，导致 %FEV1 降低。OSA 对成年患者肺功能的影响需要进一步证实。哮喘增加了 OSA 患者的日间嗜睡。需要更多的研究来调查哮喘对 OSA 严重程度的影响，以及不同 OSA 严重程度对哮喘患病率的影响。强烈建议中重度或难以控制的哮喘患者筛查 OSA 并进行适当治疗。
