Frequency of obstructive sleep apnea in patients with asthma: a systematic review and meta-analysis

Abstract

Background: Asthma is a prevalent respiratory disease that often coexists with obstructive sleep apnea (OSA). The objective of this study was to evaluate whether individuals with asthma are associated with a higher frequency of OSA. Methods: We performed a systematic review including cross-sectional and cohort studies that evaluated adult participants with and without asthma and reported OSA diagnosed via polysomnography or respiratory polygraphy. We searched PubMed, Web of Science and Scopus. Risk of bias was assessed using the ROBINS-E tool. Certainty of evidence was evaluated using the GRADE Framework. We performed a random-effects meta-analysis of odds ratios (OR) to quantify the association between asthma and OSA. Results: We included 9 studies (N = 18,916 participants). In overall patients with asthma, the association with OSA (OR=1.4; 95%CI=0.9;2.2; I²=74%) was weaker than that observed in patients with moderate to severe asthma (OR=10.1;95%CI=1.3;81.7). Asthmatic patients exhibited slightly higher apnea-hypopnea index and oxygen desaturation index, along with lower mean oxygen saturation compared to non-asthmatic patients. Conclusions: This meta-analysis identified an association between asthma (particularly moderate to severe asthma) and OSA. Future research should prioritize prospective cohort studies assessing the incidence of OSA in individuals with asthma, while controlling for referral bias and asthma severity.