Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma.
BACKGROUND
A high prevalence of obstructive sleep apnea (OSA) symptoms was reported in patients with asthma. Our goal was to evaluate factors associated with habitual snoring and OSA risk in these patients.


METHODS
Patients with asthma were surveyed at specialty clinics with the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) and questions about the frequency of asthma symptoms (National Asthma Education and Prevention Program guidelines), followed by medical record review. SA-SDQ scores >or= 36 for men and >or= 32 for women defined high OSA risk. Logistic regression was used to model associations with habitual snoring and high OSA risk.


RESULTS
Among 244 patients, 37% snored habitually and 40% demonstrated high OSA risk. Independent predictors of habitual snoring included gastroesophageal reflux disease (GERD) [odds ratio (OR), 2.19; 95% confidence interval (CI), 1.19 to 4.02] and use of an inhaled corticosteroid (ICS) [OR, 2.66; 95% CI, 1.05 to 6.72]. High OSA risk was predicted by asthma severity step (OR, 1.59; 95% CI, 1.23 to 2.06), GERD (OR, 2.70; 95% CI, 1.51 to 4.83), and ICS use (OR, 4.05; 95% CI, 1.56 to 10.53). Linear, dose-dependent relationships of ICS with habitual snoring and high OSA risk were seen (p = 0.004 and p = 0.0006, respectively). Women demonstrated a 2.11 times greater odds for high OSA risk (95% CI, 1.10 to 4.09) when controlling for the above covariates.


CONCLUSIONS
Symptoms of OSA in patients with asthma are predicted by asthma severity, coexistent GERD, and use of an ICS in a dose-dependent fashion. The well-recognized male gender predominance for OSA symptoms is not apparent in these patients. Further exploration of these relationships may help to explain the increased prevalence of OSA in asthma and provide new insights into the reported female predominance of asthma morbidity.
Department of Medicine and Wisconsin Sleep Institute, University of Wisconsin, Madison, WI; Medical Service and Sleep Disorders Center, William S. Middleton Veterans Hospital, Madison, WI. Electronic address: mt3@medicine.wisc.edu.
Mihaela
M
Teodorescu
Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI.
Flavia B
FB
Consens
Department of Medicine, University of Michigan Health System, Ann Arbor, MI.
William F
WF
Bria
Department of Medicine, University of Michigan Health System, Ann Arbor, MI.
Michael J
MJ
Coffey
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Marc S
MS
McMorris
Michigan Institute for Clinical and Health Research, University of Michigan Health System, Ann Arbor, MI.
Kevin J
KJ
Weatherwax
Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI.
John
J
Palmisano
Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI.
Carolyn M
CM
Senger
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Yining
Y
Ye
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Jack D
JD
Kalbfleisch
Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI.
Ronald D
RD
Chervin
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D012913:Snoring / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D055815:Young Adult
D000305:Adrenal Cortex Hormones