Can Asthma and Sleep Apnea Overlap in the Same Person?
Editor's note: This article was originally published on our sister site, Sleepapnea.Sleep-Disorders.net by Tamara Sellman.
The person with asthma may struggle with breathing throughout the day, only to encounter even more issues at bedtime. Does asthma have a relationship to sleep breathing disorders like obstructive sleep apnea (OSA), or might it be a separate concern? This is a question long asked by researchers.
Similarities between asthma and sleep apnea
On the one hand, both conditions occur, usually, at different times of the day. How we breathe during the day, while we are awake, is technically different from how we breathe at night while we sleep.
On the other hand, both are conditions of the respiratory system. They’re also extremely common, each affecting more than 20 million Americans. And they both share air pollution and allergens as triggers. Another risk factor common to both: obesity.1-5
It’s possible to have both conditions, of course. If you have asthma, have you wondered whether your bedtime breathing concerns might also be OSA? Or, if you have OSA, do you know that problems with acid reflux, pollution, or allergies may be linked to asthma?
How do they overlap?
How do OSA and asthma overlap, and what can you do for relief if you have both conditions?
One doesn’t cause the other, but both conditions, if untreated or poorly managed, can aggravate the other.
How asthma relates to OSA
Episodes of asthma sometimes occur while you try to sleep. However, a nighttime asthma attack can do more than lead to coughing attacks and shortness of breath. Ongoing inflammation occurs which may also result in periods of obstructed breathing (apneas).6
This disruption of sleep stages all night long leads to daytime periods of excessive sleepiness. While OSA may cause this daytime fatigue, chronic problems with asthma are another common pathway to that same experience of daytime somnolence.6
Uncontrolled asthma can also contribute to other concerns usually linked to OSA, like drowsy driving, mood swings, insulin and blood sugar imbalances, and high blood pressure.6,7
How OSA relates to asthma
Acid reflux commonly occurs in people with OSA. Breathing problems create pressure problems in both the airways and the alimentary canal (which include the stomach and esophagus).
The result? Many with untreated OSA regurgitate their stomach contents during sleep.
This highly acidic backflow may creep back into the throat and, in a gasping fit following an apnea, enter the delicate airways of the lungs in an action known as aspiration (breathing in substances not meant for the lungs).
Aspiration can damage and scar the lung tissue and may even lead to the development of asthma if it occurs on a nightly basis.6
The obesity connection
The connection may be simple to understand, yet equally difficult to manage.
The higher your body mass index (BMI), the more weight you carry. Our fat cells, in particular, retain fluids. When we recline to sleep, the fatty tissues in the neck region absorb and redistribute that fluid, plumping up these tissues. This places weight and pressure against the upper airway.8
Restricted airways are a chief reason why both apneas and asthma attacks happen in the first place.8
Obesity remains a common aggravator in both cases. The swollen tissues that can interfere with breathing include fat pads around the neck walls as well as the tongue, tonsils, adenoids, uvula, and epiglottis.8
During the day, fatigue from breathing challenges—either from OSA, from asthma, or from both—can also come as a side effect of chronic obesity.8
What if you think you have both?
The obvious first step: talk to your sleep or asthma specialist about your concerns. You may only have one or the other condition, or both in a way that overlaps, creating nightly demands on your airways that will call for therapeutic support.
You’ll need to participate in special tests so the doctor can identify whether you might have both conditions, or whether you need more and better therapeutic approaches for the OSA or asthma you already have.
Do I need a CPAP?
When OSA and asthma occur together (what we call comorbidities), OSA can lead to a higher frequency of severe asthma exacerbations.8
The gold standard therapy for OSA is positive airway pressure (PAP) therapy. Forms of this include CPAP, Bilevel PAP, and AutoPAP. Why not consider it a potential therapy for asthma?9
Research shows that PAP can improve poorly controlled asthma. The same airway inflammation, fragmented sleep, erratic levels of blood oxygen, and disrupted lung function that CPAP corrects for OSA can also be corrected in people with asthma.9
Do you have asthma and obstructive sleep apnea? Share your experience with us.
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