哮喘联盟

   摘要
   重要性：阻塞性睡眠呼吸暂停（OSA）在哮喘患者中相当常见，但哮喘与OSA发展的相关性尚不明确。
   目的：旨在评估阻塞性睡眠呼吸暂停（OSA）发病与哮喘的潜在相关性实验设计、机构及受试者：基于人群的前瞻性流行病学研究（威斯康星州睡眠队列研究）开始于1988年。成人受试者来自威斯康星洲从业人员的随机样本，这些从业人员参与每隔4年的整晚多导睡眠监测研究。2013年3月在多导睡眠监测研究期间评估哮喘及协变量信息。通过2个基线多导睡眠监测研究确定无OSA（低通气指数 [AHI] <5次/小时且未治疗）的受试者纳入研究。共547例受试者每隔4年的1105次随访（52%为女性；平均[SD]基线年龄，50 [8] 岁）。
   暴露：问卷评估患者自述医生诊断的哮喘发病及持续时间。
   主要结果及测量方法：采用Poisson回归分析重复测量，评估哮喘发病及持续时间与每4年的OSA （AHI ≥ 5 或气道正压治疗）和OSA伴习惯性日间嗜睡发生率的相关性，并校正混杂因素。
   结果：81 例受试者中22例（27%[95 %可信区间(CI)，17%-37%]），在其第一个四年随访观察期中，报告有伴随OSA发作的情况。而另外466例无哮喘受试者中，75例报告有OSA症状（16%[95 % CI，13%-19%]）。考虑所有受试者的四年间隔，在167个四年间隔中，哮喘受试者共计45例伴有OSA发作的情况（27%[95 %CI，17%-37%]），而无哮喘的受试者在938个四年间隔中，共计有160例伴有OSA发作的情况(17% [95 % CI, 15%-19%])。控制性别，年龄，基线，身体质量指数变化和其他因素后，对应校正的相对危险度（RR）为1.39（95 % CI，1.06-1.82）。哮喘也与伴有习惯性嗜睡的初发OSA相关（RR，2.72 [95 %CI，1.26-5.89]，P = .045)。哮喘持续时间与OSA发生和(RR, 1.07每5年哮喘持续时间的增量[95 % CI, 1.02-1.13], P = .01)伴有习惯性嗜睡的OSA发生均相关(RR，1.18 [95 % CI，1.07-1.31]，P=02）。
   结论和相关性：哮喘与初发OSA的风险增加相关。本研究调查了该潜在相关性的机制，并证实了定期评估哮喘患者OSA的价值。
 

（林江涛 审校）
JAMA. 2015 Jan 13;313(2):156-64. doi: 10.1001/jama.2014.17822.
 

Association between asthma and risk of developing obstructive sleep apnea.
 

Teodorescu M1, Barnet JH2, Hagen EW2, Palta M3, Young TB2, Peppard PE2.
 

Abstract
IMPORTANCE: Obstructive sleep apnea (OSA) is more common among patients with asthma; whether asthma is associated with the development of OSA is unknown.
OBJECTIVE: To examine the prospective relationship of asthma with incident OSA.
DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective epidemiologic study (the Wisconsin Sleep Cohort Study) beginning in 1988. Adult participants were recruited from a random sample of Wisconsin state employees to attend overnight polysomnography studies at 4-year intervals. Asthma and covariate information were assessed during polysomnography studies through March 2013. Eligible participants were identified as free of OSA (apnea-hypopnea index [AHI] of <5 events/h and not treated) by 2 baseline polysomnography studies. There were 1105 4-year follow-up intervals provided by 547 participants (52% women; mean [SD] baseline age, 50 [8] years).
EXPOSURES: Questionnaire-assessed presence and duration of self-reported physician-diagnosed asthma.
MAIN OUTCOMES AND MEASURES: The associations of presence and duration of asthma with 4-year incidences of both OSA (AHI of ≥5 or positive airway pressure treatment) and OSA concomitant with habitual daytime sleepiness were estimated using repeated-measures Poisson regression, adjusting for confounders.
RESULTS: Twenty-two of 81 participants (27% [95% CI, 17%-37%]) with asthma experienced incident OSA over their first observed 4-year follow-up interval compared with 75 of 466 participants (16% [95% CI, 13%-19%]) without asthma. Using all 4-year intervals, participants with asthma experienced 45 cases of incident OSA during 167 4-year intervals (27% [95% CI, 20%-34%]) and participants without asthma experienced 160 cases of incident OSA during 938 4-year intervals (17% [95% CI, 15%-19%]); the corresponding adjusted relative risk (RR) was 1.39 (95% CI, 1.06-1.82), controlling for sex, age, baseline and change in body mass index, and other factors. Asthma was also associated with new-onset OSA with habitual sleepiness (RR, 2.72 [95% CI, 1.26-5.89], P = .045). Asthma duration was related to both incident OSA (RR, 1.07 per 5-year increment in asthma duration [95% CI, 1.02-1.13], P = .01) and incident OSA with habitual sleepiness (RR, 1.18 [95% CI, 1.07-1.31], P = .02).
CONCLUSIONS AND RELEVANCE: Asthma was associated with an increased risk of new-onset OSA. Studies investigating the mechanisms underlying this association and the value of periodic OSA evaluation in patients with asthma are warranted.
 

JAMA. 2015 Jan 13;313(2):156-64. doi: 10.1001/jama.2014.17822.