Page 47 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 47
in Patients with Severe Asthma-Alternative 2.2
Overlap Syndrome
Ivan Čekerevac1,2, Bojan Djokić2
Abstract 1 Faculty of Medical Sciences
Bronchial asthma and o bstructive sleep apnea (O SA) are common chronic diseases of the res- Kragujevac
piratory system. During the last decade, there has been a growing interest in the connection
between these two disorders. Studies show that asthma patients are at increased risk for OSA, 2 Clinic for pulmonology,
and the prevalence is on average around 70% in severe asthma patients. Rhinitis, gastroesoph- University Clinical Center
ageal reflux disease and obesity are common comorbidities for both entities. O SA is an inde- Kragujevac
pendent factor in the exacerbation of asthma and each condition in itself can contribute to the
exacerbation of the other. Asthma, by its mechanical effect, has a direct impact on OSA, lead-
ing to greater collapse of the upper airway and worsening snoring and apnea symptoms in pa-
tients with O SA. On the other hand, O SA directly affects asthma through nerve reflexes, in-
termittent hypoxia, increases inflammation, increases the production of leptin and vascular
endothelial growth factor as well as sleep fragmentation. Indirect effects in a bidirectional in-
teraction are reflected in the prolonged effects of systemic corticosteroids, chronic diseases of
the upper respiratory tract, tobacco use and increased body weight in asthmatics, which leads
to worsening of OSA symptoms. It remains unclear whether OSA in asthmatics is merely a co-
morbidity or a specific new phenotype of asthma. In patients with asthma and OSA, CPAP
treatment reduces asthma symptoms, improves morning expiratory flow, and improves qual-
ity of life parameters.
Keywords: severe asthma, O SA, alternative overlap syndrome
Bronchial asthma and obstructive sleep ap- chial asthma3. Studies show that asthma suf-
nea (OSA) are frequent chronic diseases of ferers have an increased risk of OSA, and the
the respiratory system. During the last dec- prevalence is on average around 70% in severe
ade, there has been a growing interest in the asthma sufferers4. Many patients with asth-
connection between these two disorders. For ma report poor sleep quality, daytime sleepi-
this reason, the term Alternative Overlap Syn- ness and higher frequency of snoring during
drome (Asthma and OSA) was introduced in sleep than in the general population5. These
2013, to distinguish it from the classic Over- symptoms are common in patients with OSA,
lap Syndrome (COPD and OSA). There is indicating a connection between the two dis-
more and more evidence that OSA is associat- orders6. Similar pathophysiological mecha-
ed with increased bronchial hypersensitivity1 nisms are observed in both disorders, which
and inflammation2 and thus may be an inde- are manifested by an increase in local and sys-
pendent risk factor for exacerbation of bron- temic inflammation, and common comorbidi-
https://doi.org/10.26 493/978 -961-293 -297-8.47-51
Overlap Syndrome
Ivan Čekerevac1,2, Bojan Djokić2
Abstract 1 Faculty of Medical Sciences
Bronchial asthma and o bstructive sleep apnea (O SA) are common chronic diseases of the res- Kragujevac
piratory system. During the last decade, there has been a growing interest in the connection
between these two disorders. Studies show that asthma patients are at increased risk for OSA, 2 Clinic for pulmonology,
and the prevalence is on average around 70% in severe asthma patients. Rhinitis, gastroesoph- University Clinical Center
ageal reflux disease and obesity are common comorbidities for both entities. O SA is an inde- Kragujevac
pendent factor in the exacerbation of asthma and each condition in itself can contribute to the
exacerbation of the other. Asthma, by its mechanical effect, has a direct impact on OSA, lead-
ing to greater collapse of the upper airway and worsening snoring and apnea symptoms in pa-
tients with O SA. On the other hand, O SA directly affects asthma through nerve reflexes, in-
termittent hypoxia, increases inflammation, increases the production of leptin and vascular
endothelial growth factor as well as sleep fragmentation. Indirect effects in a bidirectional in-
teraction are reflected in the prolonged effects of systemic corticosteroids, chronic diseases of
the upper respiratory tract, tobacco use and increased body weight in asthmatics, which leads
to worsening of OSA symptoms. It remains unclear whether OSA in asthmatics is merely a co-
morbidity or a specific new phenotype of asthma. In patients with asthma and OSA, CPAP
treatment reduces asthma symptoms, improves morning expiratory flow, and improves qual-
ity of life parameters.
Keywords: severe asthma, O SA, alternative overlap syndrome
Bronchial asthma and obstructive sleep ap- chial asthma3. Studies show that asthma suf-
nea (OSA) are frequent chronic diseases of ferers have an increased risk of OSA, and the
the respiratory system. During the last dec- prevalence is on average around 70% in severe
ade, there has been a growing interest in the asthma sufferers4. Many patients with asth-
connection between these two disorders. For ma report poor sleep quality, daytime sleepi-
this reason, the term Alternative Overlap Syn- ness and higher frequency of snoring during
drome (Asthma and OSA) was introduced in sleep than in the general population5. These
2013, to distinguish it from the classic Over- symptoms are common in patients with OSA,
lap Syndrome (COPD and OSA). There is indicating a connection between the two dis-
more and more evidence that OSA is associat- orders6. Similar pathophysiological mecha-
ed with increased bronchial hypersensitivity1 nisms are observed in both disorders, which
and inflammation2 and thus may be an inde- are manifested by an increase in local and sys-
pendent risk factor for exacerbation of bron- temic inflammation, and common comorbidi-
https://doi.org/10.26 493/978 -961-293 -297-8.47-51
