title: Association between asthma and risk of developing obstructive sleep apnea.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  Questionnaire-assessed presence and duration of self-reported physician-diagnosed asthma.
  
  
  METHODS
  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
  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.
authors.affiliation: James B. Skatrud Pulmonary/Sleep Research Laboratory, William S. Middleton Memorial Veteran's Hospital, Madison, Wisconsin2Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison3Center for Sleep Medicine and Sleep Re.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Teodorescu
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Jodi H
authors.initials: JH
authors.lastname: Barnet
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Erika W
authors.initials: EW
authors.lastname: Hagen
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison5Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Mari
authors.initials: M
authors.lastname: Palta
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Terry B
authors.initials: TB
authors.lastname: Young
authors.affiliation: Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D014922:Wisconsin / Q000453:epidemiology