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Sleep and Breathing

, Volume 20, Issue 4, pp 1217–1224 | Cite as

Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

  • Paula Kauppi
  • Patrick Bachour
  • Paula Maasilta
  • Adel Bachour
Sleep Breathing Physiology and Disorders • Original Article

Abstract

Purpose

Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms.

Methods

A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test™ (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution.

Results

We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p < 0.001), and ACT score increased significantly from 15.35 (5.3) to 19.8 (4.6) (p < 0.001) without a significant change in the body mass index (BMI). The percentage of patients using rescue medication daily reduced from 36 to 8 % with CPAP (P < 0.001).

Conclusions

We noticed a significant decrease in asthma symptoms with long-term use of CPAP in patients with both asthma and obstructive sleep apnoea.

Keywords

Asthma Obstructive sleep apnoea CPAP 

Notes

Acknowledgments

PK and AB had full access to all of the data and contributed substantially to the study design, data analysis and interpretation and the writing of the manuscript. PB had full access to data and contributed substantially to the data analysis and writing of the manuscript. PM contributed substantially to the study design, data interpretation and the writing of the manuscript.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

The Helsinki University Special Fund provided financial support in the form of research grant funding. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Auckley D, Moallem M, Shaman Z, Mustafa M (2008) Findings of a Berlin questionnaire survey: comparison between patients seen in an asthma clinic versus internal medicine clinic. Sleep Med 9:494–499CrossRefPubMedGoogle Scholar
  2. 2.
    Ekici A, Ekici M, Kurtipek E, Keles H, Kara T, Tunckol M, Kocyigit P (2005) Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life. Chest 128:3358–3363CrossRefPubMedGoogle Scholar
  3. 3.
    Teodorescu M, Barnet JH, Hagen EW, Palta M, Young TB, Pepppard PE (2015) Association between asthma and risk of developing obstructive sleep apnea. JAMA 313:156–164CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, Erzurum S, Gaston BM, Wenzel SE, Jarjour NN, National Institutes, National Heart, Lung and Blood Institute Severe Asthma Research Program (SARP) Investigators (2015) Obstructive sleep apnea risk, asthma burden, and lower airway inflammation in adults in the Severe Asthma Research Program (SARP) II. J Allergy Clin Immunol Pract 3:566–75.e1. doi: 10.1016/j.jaip.2015.04.002 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH (2015) Risk of obstructive sleep apnea in adult patients with asthma: a population-based cohort study in Taiwan. PLoS One 10(6):e0128461. doi: 10.1371/journal.pone.0128461 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Alkhalil M, Schulman ES, Getsy J (2008) Obstructive sleep apnea syndrome and asthma: the role of continuous positive airway pressure treatment. Ann Allergy Asthma Immunol 101:350–357. doi: 10.1016/S1081-1206(10)60309-2 CrossRefPubMedGoogle Scholar
  7. 7.
    Ten Brinke A, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, Rabe KF, Bel EH (2005) Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J 26:812–818CrossRefPubMedGoogle Scholar
  8. 8.
    Luyster FS, Teodorescu M, Bleecker E, Busse W, Calhoun W, Castro M, Chung KF, Erzurum S, Israel E, Strollo PJ, Wenzel SE (2012) Sleep quality and asthma control and quality of life in non-severe and severe asthma. Sleep Breath 16:1129–1137. doi: 10.1007/s11325-011-0616-8 CrossRefPubMedGoogle Scholar
  9. 9.
    Hoffstein V, Viner S, Mateika S, Conway J (1992) Treatment of obstructive sleep apnea with nasal continuous positive airway pressure: patient compliance, perception of benefits, and side effects. Am Rev Respir Dis 145:841–845CrossRefPubMedGoogle Scholar
  10. 10.
    Reddel HK, Taylor DR, Bateman ED, et al. (2009) American Thoracic Society/European Respiratory Society Task Force on asthma control and exacerbations. an official American Thoracic Society/European Respiratory Society Statement: asthma control and exacerbations. Am J Respir Crit Care Med 180:59–99. doi: 10.1164/rccm.200801-060ST CrossRefPubMedGoogle Scholar
  11. 11.
    Viljanen AA, Halttunen PK, Kreus KE, Viljanen BC (1982) Spirometric studies in non-smoking, healthy adults. Scand J Clin Lab Invest Suppl 159:5–20CrossRefPubMedGoogle Scholar
  12. 12.
    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) Standardisation of spirometry. ATS/ERS Task Force. Eur Respir J 26:319–338CrossRefPubMedGoogle Scholar
  13. 13.
    Schatz M, Sorkness CA, Li JT, Marcus P, Murray JJ, Nathan RA, Kosinski M, Pendergraft TB, Jhingran P (2006) Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 117:549–556CrossRefPubMedGoogle Scholar
  14. 14.
    Demoly P, Bousquet PJ, Mesbah K, Bousquet J, Devillier P (2013) Visual analogue scale in patients treated for allergic rhinitis: an observational prospective study in primary care: asthma and rhinitis. Clin Exp Allergy 43:881–888. doi: 10.1111/cea.12121 CrossRefPubMedGoogle Scholar
  15. 15.
    American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. Darien, IllinoisGoogle Scholar
  16. 16.
    Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA (2001) Sleep-related disordered breathing during pregnancy in obese women. Chest 120:1448–1454CrossRefPubMedGoogle Scholar
  17. 17.
    Bachour A, Virkkala JT, Maasilta PK (2007) AutoCPAP initiation at home: optimal trial duration and cost-effectiveness. Sleep Med 8:704–710CrossRefPubMedGoogle Scholar
  18. 18.
    Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P (2009) The minimally important difference of the asthma control test. J Allergy Clin Immunol 124:719–723. doi: 10.1016/j.jaci.2009.06.053 CrossRefPubMedGoogle Scholar
  19. 19.
    Lafond C, Series F, Lemiere C (2007) Impact of CPAP on asthmatic patients with obstructive sleep apnea. Eur Respir J 29:307–311CrossRefPubMedGoogle Scholar
  20. 20.
    Devouassoux G, Levy P, Rossini E, Pin I, Fior-Gozlan M, Henry M, Seigneurin D, Pépin JL (2007) Sleep apnea is associated with bronchial inflammation and continuous positive airway pressure-induced airway hyperresponsiveness. J Allergy Clin Immunol 119:597–603CrossRefPubMedGoogle Scholar
  21. 21.
    Chan CS, Woolcock AJ, Sullivan CE (1988) Nocturnal asthma: role of snoring and obstructive sleep apnea. Am Rev Respir Dis 137:1502–1504CrossRefPubMedGoogle Scholar
  22. 22.
    Guilleminault C, Quera-Salva MA, Powell N, Riley R, Romaker A, Partinen M, Baldwin R, Nino-Murcia G (1988) Nocturnal asthma, snoring, small pharynx and nasal CPAP. Eur Respir J 1:902–907PubMedGoogle Scholar
  23. 23.
    Ciftci TU, Ciftci B, Guven SF, Kokturk O, Turktas H (2005) Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Respir Med 99:529–534CrossRefPubMedGoogle Scholar
  24. 24.
    Jantunen J, Kauppi P, Linna M, Martikainen J, Mäkelä M, Pelkonen A, Haahtela T (2014) Astman ja allergian kustannukset ovat suuret, mutta laskussa. (the costs of asthma and allergy are large but are decreasing. In Finnish). Finn Med J 9:641–647Google Scholar
  25. 25.
    Salerno FG, Carpagno E, Guido P, Bonsignore MR, Roberti A, Aliani M, Vignola AM, Spanevello A (2004) Airway inflammation in patients affected by obstructive sleep apnea syndrome. Respir Med 98:25–28CrossRefPubMedGoogle Scholar
  26. 26.
    Wenzel SE (2012) Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med 18:716–725. doi: 10.1038/nm.2678 CrossRefPubMedGoogle Scholar
  27. 27.
    Wood LG, Baines KJ, Fu J, Scott HA, Gibson PG (2012) The neutrophilic inflammatory phenotype is associated with systemic inflammation in asthma. Chest 142:86–93. doi: 10.1378/chest.11-1838 CrossRefPubMedGoogle Scholar
  28. 28.
    Schachter LM, Salome CM, Peat JK, Woolcock AJ (2001) Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax 56:4–8CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Holguin F, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Moore WC, Peters SP, Yonas M, Teague WG, Wenzel SE (2011) Obesity and asthma: an association modified by age of asthma onset. J Allergy Clin Immunol 127:1486–93. e2. doi: 10.1016/j.jaci.2011.03.036 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Drager LF, Brunoni AR, Jenner R, Lorenzi-Filho G, Benseñor IM, Lotufo PA (2015) Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax 70:258–264. doi: 10.1136/thoraxjnl-2014-205361 CrossRefPubMedGoogle Scholar
  31. 31.
    Hanon S, Schuermans D, Vincken W, Verbanck S (2014) Irreversible acinar airway abnormality in well controlled asthma. Respir Med 108:1601–1607. doi: 10.1016/j.rmed.2014.07.019 CrossRefPubMedGoogle Scholar
  32. 32.
    Prasad B, Nyenhuis SM, Weaver TE (2014) Obstructive sleep apnea and asthma: Associations and treatment implications. Sleep Med Rev 18:165–171. doi: 10.1016/j.smrv.2013.04.004 CrossRefPubMedGoogle Scholar
  33. 33.
    Bachour A, Vitikainen P, Virkkula P, Maasilta P (2013) CPAP interface: satisfaction and side effects. Sleep Breath 17:667–672CrossRefPubMedGoogle Scholar
  34. 34.
    D’Amato M, Stanziola AA, de Laurentiis G, Diana R, Russo C, Maniscalco M, D’amato G, Sofia M (2014) Nocturnal continuous positive airway pressure in severe non-apneic asthma. A pilot study. Clin Respir J 8:417–424. doi: 10.1111/crj.12088 CrossRefPubMedGoogle Scholar
  35. 35.
    Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea divices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7:531–548PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Paula Kauppi
    • 1
  • Patrick Bachour
    • 2
  • Paula Maasilta
    • 2
  • Adel Bachour
    • 2
  1. 1.Inflammation Centre, Skin and Allergy HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
  2. 2.Heart and Lung CentreUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland

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