哮喘联盟

   摘要
   重要性：阻塞性睡眠呼吸暂停（Obstructive sleep apnea: OSA）在哮喘患者中较为常见；但哮喘是否与OSA的发展具有相关性尚不清楚。
   目的：探索哮喘与发生OSA的潜在关系。
   试验设计、研究地点与受试者：该研究为一项开始于1988年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）。成年受试者招募于威斯康星州的工薪阶层的一个随机样本，这些受试者在每隔4年的随访期中接受整夜的多导睡眠监测。在2013年3月评估受试者在多导睡眠监测中的哮喘及其它相关信息。合格的受试者在两次基线多导呼吸睡眠监测中应处于非OSA状态（呼吸暂停低通气指数（apnea-hypopnea index，AHI）小于5次/小时且未接受治疗）。547例受试者共参与了1105个4年随访期（52%女性；平均[标准差]基线年龄50[8]岁）。
   暴露因素：采用调查问卷来评估受试者自我报告医生诊断的哮喘的发生与病程。
   主要结局与测量指标：运用重复测量的Poisson回归（校正混杂因素）评估哮喘的发生和病程与OSA以及OSA伴随习惯性日间嗜睡4年发生率之间的关系。
   结果：81例哮喘受试者中有22（27%[95%CI, 17%-37%]）例在他们第1个4年随访期中发生OSA，466例非哮喘患者中75例（16%[95%CI, 13%-19%）发生OSA。在167个4年随访期中，哮喘组受试者有45个随访期（27%[95%CI,20%-34%]）发生了OSA，但是非哮喘组938个4年随访期（17%[95%CI, 15%-19%]）中，有160个发生了OSA。将性别、年龄、BMI基线及改变量以及其它相关协变量进行校正后，哮喘与非哮喘患者发生OSA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新发OSA相关（RR, 2.72 [95%CI, 1.26-5.89], P = .045）。哮喘病程与OSA（以5年为间隔，RR, 1.07 [95%CI, 1.02-1.13], P = .01）以及伴有习惯性嗜睡的OSA（RR, 1.18 [95%CI, 1.07-1.31], P = .02）均具有相关性。
   结论与相关性：哮喘与新发OSA风险相关，且病程越长风险越高。需要进一步研究该联系的机制并探讨定期对哮喘患者进行OSA评估的价值。

 

(张欣 张红萍 王刚 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Peppard PE.JAMA. 2015; 313(2): 156-164.）


 

Association Between Asthma and Risk of Developing Obstructive Sleep Apnea

Teodorescu M; Barnet JH;  Hagen EW; Palta M; Young TB;

 Peppard PE.JAMA. 2015; 313(2): 156-164.

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.