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Sleep Apnea and Asthma

How Sleep Apnea Worsens Asthma

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Updated March 23, 2009

What is Sleep Apnea?

Obstructive sleep apnea syndrome, or simply sleep apnea, is a disease process caused by repeated episodes of closing of the upper airway during sleep, resulting in the reduction of airflow and oxygen to the lungs. This can lead to low oxygen levels in the blood stream, gasping episodes and frequent nighttime awakenings.

Most people with obstructive sleep apnea snore loudly, stop breathing during sleep, and have episodes of gasping, choking, gagging and coughing. Often, the person isn’t aware that he is waking up dozens of times during the night as a result of trouble breathing, but these episodes lead to restless sleep and therefore daytime fatigue, regardless of how many hours the person tries to sleep.

Is There an Association Between Sleep Apnea and Asthma?

Studies suggest that people with asthma may be at increased risk for sleep apnea, and that sleep apnea can worsen asthma. Sleep apnea worsens asthma in a number of ways, such as increasing gastroesophageal reflux (acid reflux), contributing to weight gain and obesity, causing decreased airflow in the airways of the lungs, and may cause increased inflammation throughout the body (including the lungs).

Sleep apnea can cause and/or worsen acid reflux, probably by decreasing the ability of the sphincter muscles in the esophagus to keep acid in the stomach. Acid reflux during sleep is well-known to cause and worsen night-time asthma symptoms.

Sleep apnea may cause an increase in the amount of inflammatory chemicals within the bloodstream, which could worsen the inflammation in the lungs caused by asthma. These inflammatory chemicals also contribute to weight gain and obesity, which further worsens asthma.

Airflow is decreased during sleep apnea, leading to low oxygen levels in the blood stream and strain on the heart. Narrowing of the small airways also leads to more irritation and contraction of the smooth muscle around the airways in people with asthma, worsening asthma symptoms.

What Is the Treatment for Sleep Apnea?

Continuous positive airway pressure (CPAP) is the preferred therapy for obstructive sleep apnea. CPAP involves the patient wearing a mask during sleep that provides a continuous stream of pressurized air to keep the airways open. There is a surgical option for the treatment of obstructive sleep apnea, called a uvulopalatopharyngeoplasty (UP3). But in my opinion and experience, this is rarely helpful, and most people wind up needing CPAP anyway.

CPAP seems to reverse many of the harmful effects of sleep apnea. Acid reflux is improved with the use of CPAP through the increase in the ability of sphincter muscles in the esophagus to keep acid in the stomach. Inflammatory chemicals caused by sleep apnea decrease with the use of CPAP, which may result in less inflammation within the body and the lungs. Airflow within the airways is increased with the use of CPAP, leading to opening of the airways, better oxygenation of the lungs, and decreased contraction of the smooth muscles around the airways. All of these effects lead to improvement in asthma control in people with asthma and sleep apnea.

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Source:

Alkhalil M, Schulman ES, Getsy J. Ostructive Sleep Apnea Syndrome and Asthma: The Role of Continuous Positive Airway Pressure Treatment. Ann Allergy Asthma Immunol. 2008;101:350-7.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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