Abstract
Background: Inhaled corticosteroids (ICS) produce local effects on upper airway dilators that could increase the risk of developing obstructive sleep apnea (OSA). Given that the particle size of ICS changes their distribution, the particle size of ICS may impact the risk of developing OSA. Objectives: In this large retrospective study, we explore the relationship of ICS use and OSA in patients with asthma. In addition, we seek to determine if this relationship is affected by the particle size of ICS. Methods: Using electronic health records, we established a cohort of 29,816 asthmatics aged 12 and older with a diagnosis of asthma documented by ICD-9 or ICD-10 codes between January 2011 and August 2016. We performed analyses of variance and multivariate logistic regression analysis to determine the effects ICS on the diagnosis of OSA with sub-analysis by particle size of ICS. Results: Uncontrolled asthmatics showed increased odds of receiving a diagnosis of OSA whether when looking at ACT scores (adjusted odds ratio (aOR) 1.60, 95% CI 1.32–1.94) or PFT results (aOR 1.45, 95% CI 1.19–1.77). Users of ICS also had increased odds of OSA independent of asthma control (aOR 1.58, 95% CI 1.47–1.70). Notably, users of extra-fine particle ICS did not have significantly increased odds of having OSA compared to non-users of ICS (aOR 1.11, 95% CI 0.78–1.58). Conclusions: Use of ICS appears to be an independent risk factor for OSA. Notably, extra-fine particle size ICS do not appear to be associated with an increased risk of OSA.
Highlights
Asthma has been associated with sleep disturbances and the development of obstructive sleep apnea (OSA), the mechanisms that underlie the relationship and the optimal approaches to subsequent therapy have not been well described [1,2,3,4,5,6,7]
Our results suggest that the use of Inhaled corticosteroids (ICS) may be an independent risk factor for the development of OSA, especially in already at-risk patients such as overweight males
The use of ICS may produce local effects on the upper airway dilators that increase the risk of developing OSA, similar to the underlying mechanisms that increase the risk of dysphonia in ICS users [10]
Summary
Asthma has been associated with sleep disturbances and the development of obstructive sleep apnea (OSA), the mechanisms that underlie the relationship and the optimal approaches to subsequent therapy have not been well described [1,2,3,4,5,6,7]. Inhaled corticosteroids (ICS) are known to increase the risk for dysphonia by causing myopathy of the vocal cord adductors [10]. ICS may produce similar local effects on the upper. Inhaled corticosteroids (ICS) produce local effects on upper airway dilators that could increase the risk of developing obstructive sleep apnea (OSA). Given that the particle size of ICS changes their distribution, the particle size of ICS may impact the risk of developing OSA
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