Low arousal threshold: a common pathophysiological trait in patients with obstructive sleep apnea syndrome and asthma,Sleep and Breathing

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Low arousal threshold: a common pathophysiological trait in patients with obstructive sleep apnea syndrome and asthma
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-07-30 , DOI: 10.1007/s11325-022-02665-4
Caterina Antonaglia ₁ , Giovanna Passuti ₂ , Fabiola Giudici ₃ , Francesco Salton ₁ , Barbara Ruaro ₁ , Dejan Radovanovic ₄ , Marco Confalonieri ₁

Affiliation

Introduction

Obstructive sleep apnea syndrome (OSAS) and asthma are two diseases with a high epidemiological impact that may often coexist. Both diseases have underlying pathogenic mechanisms (chronic inflammation, genetic predisposition, etc.); it is still unclear whether or not their coexistence is due to a specific pathophysiological factor. In the literature, the pathogenesis of OSAS has four pathophysiological traits: one or more anatomical predisposing factors, a low arousal threshold (low AT), high loop gain, and poor muscle responsiveness. In this study, we hypothesized that a low AT is a common pathophysiological factor in OSAS and asthma.

Methods

A retrospective study of patients attending the Pulmonology Unit of the University Hospital of Trieste was carried out. Low AT was predicted on the bases of the following polysomnography features, as previously shown by Edwards et al.: an AHI of < 30 events/h, a nadir SpO2 of > 82.5%, and a hypopnea fraction of total respiratory events of > 58.3%.

Results

Thirty-five patients with asthma and OSAS and 36 with OSAS alone were included in the study. Low AT was present in 71% of patients affected by asthma and OSAS (25 patients out of 35) versus 31% (11 patients out of 36) of patients affected by OSAS alone with a statistically significant difference (p = 0.002) between the two groups. Stratifying for BMI and OSAS severity, the difference between groups remained statistically significant.

Conclusions

This is the first study to describe specific polysomnographic characteristics of patients affected by asthma and OSAS. A low AT may well be the pathophysiological factor common to the two diseases. If confirmed by other studies, this finding could lead to the presence of asthma and OSAS in the same individual being considered a syndrome with a common pathophysiological factor.

中文翻译：

低觉醒阈值：阻塞性睡眠呼吸暂停综合征和哮喘患者的常见病理生理特征

介绍

阻塞性睡眠呼吸暂停综合征 (OSAS) 和哮喘是两种具有高度流行病学影响的疾病，可能经常并存。两种疾病都有潜在的致病机制（慢性炎症、遗传易感性等）；目前尚不清楚它们的共存是否是由于特定的病理生理因素。在文献中，OSAS的发病机制具有四种病理生理特征：一种或多种解剖学诱发因素、低觉醒阈值（低AT）、高环路增益和差的肌肉反应性。在这项研究中，我们假设低 AT 是 OSAS 和哮喘的常见病理生理因素。

方法

对就诊于的里雅斯特大学医院肺病科的患者进行了一项回顾性研究。低 AT 是根据以下多导睡眠图特征预测的，如 Edwards 等人先前所示：AHI < 30 事件/小时，最低点 SpO2 > 82.5%，总呼吸事件的低通气分数 > 58.3 %。

结果

该研究包括 35 名患有哮喘和 OSAS 的患者以及 36 名仅患有 OSAS 的患者。 71% 受哮喘和 OSAS 影响的患者（35 名患者中有 25 名患者）存在低 AT，而仅受 OSAS 影响的患者为 31%（36 名患者中有 11 名患者），两者之间存在统计学显着差异 (p = 0.002 )团体。对 BMI 和 OSAS 严重程度进行分层，组间差异仍然具有统计学意义。