Airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), come with their own host of issues and challenges, but added complications due to sleep disorders, like obstructive sleep apnea (OSA), can bring other comorbidities to the table.
At the 2018 CHEST Annual Meeting in San Antonio, TX, Amir A. Zeki, MD, associate professor of medicine at The University of California, Davis, specialist in pulmonary and critical care medicine, spoke with MD Magazine® to explain the relationship between sleep disorders and airway diseases.
MD Mag: What is the relationship between sleep medicine and airway diseases?
Zeki: Obstructive [sleep apnea] or central sleep apnea are very prevalent—in particular, OSA. They do overlap in airway diseases. There is some correlation or epistemological data that shows your asthma is much worse if you have OSA that is not being treated.
It is incredibly important to identify sleep apnea in general, let alone in the setting of airway disease where it becomes more important.
What we do in the clinic is, if we have a patient we suspect has sleep apnea, we work them up aggressively and we treat it [the suspected sleep apnea], and we make sure they [patients] are compliant because it makes treating their asthma and COPD—at least anecdotally—much easier. There is literature to support that as well.
The pathophysiological mechanisms are interesting and ‘probably’—in quotations, because we haven’t worked that out yet—are related to periods of hypoxemia (when patients are asleep)—and that can trigger all kinds of inflammatory pathways in the body systemically, let alone in the lung. That may actually make your asthma or COPD worse in the daytime or working hours. That is 1 reasonable hypothesis.
MD Mag: What are the comorbidities associated between sleep disorders and airway diseases?
The older you are, and if you have COPD or overlap [COPD-asthma overlap], the more likely you are to have cardiovascular comorbidities—hypertension, coronary disease, history of stroke, etc. That aspect seems to correlate more with age, COPD, and overlap [asthma-COPD-overlap]. When we looked at our clinic, we saw the same thing.
If you have OSA, that in and of itself increases your risks for hypertension and potential negative cardiovascular outcomes, like heart failure, sudden death, and things like that. Those comorbidities do go together.
If you just have asthma, it’s less prevalent, but it can be there as well, especially if there is obesity with asthma.
A lot of these comorbidities overlap, but if you have identified patients as having COPD if they’re older, then the risk of cardiovascular comorbidities—at least the prevalence—is actually higher.
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