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Becerra M.B.,California State University, San Bernardino | Becerra B.J.,Loma Linda University | Teodorescu M.,James B Skatrud Pulmonary Sleep Research Laboratory | Teodorescu M.,University of Wisconsin - Madison
Respiratory Medicine | Year: 2016

Background Studies have highlighted the significant comorbidities of both obesity and obstructive sleep apnea (OSA) among asthma patients in outpatient settings, but such data in the inpatient setting is sparse. Methods Using 2009–2011 U.S. Nationwide Inpatient Sample; survey-weighted regression analyses were conducted to address the role of obesity, OSA, and both obesity and OSA on length of stay (LOS), total hospital charges, need for respiratory therapy, and disposition among adults with primary asthma hospitalization (n = 179,789). Results Males had a higher prevalence of OSA than females (5.23% vs. 3.88%), while females had a higher prevalence of obesity (17.21% vs. 8.95%) and both obesity and OSA (7.11% vs. 6.19%). Increased hospital LOS was associated with presence of obesity (incidence rate ratio [IRR] males = 1.07, IRR females = 1.08), OSA (IRR males = 1.07, IRR females = 1.14), and both obesity and OSA (IRR males = 1.19, IRR females = 1.24). Increased total hospital charges was related to obesity (8.64% for males and 9.61% for females), OSA (15.39% for males and 19.13% for females), and both comorbidities (24.94% for males and 28.50% for females). Presence of OSA alone increased odds of need for respiratory therapy for males (odds ratio [OR] = 2.56) and females (OR = 3.22), as did presence of both comorbidities (OR males = 2.85, OR females = 3.60). Odds of routine disposition was lower among females with both comorbidities (OR = 0.82). Conclusion Compared to obesity alone, OSA and both obesity and OSA are associated with increased health resource utilization and poorer inpatient outcomes. This demonstrates the need for further clinical investigations of early detection of OSA among such at-risk populations. © 2016 Elsevier Ltd Source


Teodorescu M.,James B Skatrud Pulmonary Sleep Research Laboratory | Teodorescu M.,University of Wisconsin - Madison | Polomis D.A.,University of Wisconsin - Madison | Gangnon R.E.,University of Wisconsin - Madison | And 3 more authors.
Journal of Asthma | Year: 2013

Background: Obesity is more prevalent in asthmatics. Sleep duration is a novel risk factor for obesity in general populations. Objective: We tested the association of sleep duration and asthma characteristics with obesity. Methods: Adults at tertiary clinics were surveyed on asthma symptoms and habitual sleep duration. Medical records were used to assess asthma severity step (1-4), extract height and weight, current medications and diagnosed comorbid conditions. BMI ≥30kg/m2 defined obesity. Habitual sleep was categorized as <6 (very short), 6 to <7h (short), 7-8h (normal), >8 to ≤9h (long) and >9h (very long). Inhaled corticosteroid doses were categorized as low, moderate and high. Results: Among 611 participants (mean BMI 30±8), 249 (41%) were obese. After adjustment for covariates, obesity was associated with short and very long sleep: as compared to normal sleepers, the odds of being obese were on an average 66% higher ([95% CI: 1.07-2.57], p=0.02) among short and 124% higher ([1.08-1.65], p=0.03) among very long sleepers, and the association with very short sleep approached significance (1.74 [0.96-3.14], p=0.06). Obesity was also significantly related to highest asthma step (1.87 [1.09-3.21], p=0.02) and psychopathology (1.64 [1.08-2.48], p=0.02), and a trend was seen with high-dose inhaled corticosteroids (1.82 [0.93-3.56], p=0.08). Conclusions: Obesity in asthmatics is associated with shorter and very long sleep duration, worse asthma severity, psychopathology and high-dose inhaled corticosteroids. Although this cross-sectional study cannot prove causality, we speculate that further investigation of sleep may provide new opportunities to reduce the rising prevalence of obesity among asthmatics. © 2013 Informa Healthcare USA, Inc. Source


Teodorescu M.,James B Skatrud Pulmonary Sleep Research Laboratory | Teodorescu M.,University of Wisconsin - Madison | Barnet J.H.,University of Wisconsin - Madison | Hagen E.W.,University of Wisconsin - Madison | And 3 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

IMPORTANCE: Obstructive sleep apnea (OSA) is more common among patients with asthma; whether asthma is associated with the development of OSA is unknown. OBJECTIVE: To examine the prospective relationship of asthma with incident OSA. DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective epidemiologic study (the Wisconsin Sleep Cohort Study) beginning in 1988. Adult participants were recruited from a random sample of Wisconsin state employees to attend overnight polysomnography studies at 4-year intervals. Asthma and covariate information were assessed during polysomnography studies through March 2013. Eligible participants were identified as free of OSA (apnea-hypopnea index [AHI] of <5 events/h and not treated) by 2 baseline polysomnography studies. There were 1105 4-year follow-up intervals provided by 547 participants (52%women; mean [SD] baseline age, 50 [8] years). EXPOSURES: Questionnaire-assessed presence and duration of self-reported physician-diagnosed asthma. MAIN OUTCOMES AND MEASURES: The associations of presence and duration of asthma with 4-year incidences of both OSA (AHI of ≥5 or positive airway pressure treatment) and OSA concomitant with habitual daytime sleepiness were estimated using repeated-measures Poisson regression, adjusting for confounders. RESULTS: Twenty-two of 81 participants (27%[95%CI, 17%-37%]) with asthma experienced incident OSA over their first observed 4-year follow-up interval compared with 75 of 466 participants (16%[95%CI, 13%-19%]) without asthma. Using all 4-year intervals, participants with asthma experienced 45 cases of incident OSA during 167 4-year intervals (27%[95%CI, 20%-34%]) and participants without asthma experienced 160 cases of incident OSA during 938 4-year intervals (17%[95%CI, 15%-19%]); the corresponding adjusted relative risk (RR) was 1.39 (95%CI, 1.06-1.82), controlling for sex, age, baseline and change in body mass index, and other factors. Asthma was also associated with new-onset OSA with habitual sleepiness (RR, 2.72 [95%CI, 1.26-5.89], P = .045). Asthma duration was related to both incident OSA (RR, 1.07 per 5-year increment in asthma duration [95%CI, 1.02-1.13], P = .01) and incident OSA with habitual sleepiness (RR, 1.18 [95%CI, 1.07-1.31], P = .02). CONCLUSIONS AND RELEVANCE: Asthma was associated with an increased risk of new-onset OSA. Studies investigating the mechanisms underlying this association and the value of periodic OSA evaluation in patients with asthma are warranted. Copyright 2014 American Medical Association. All rights reserved. Source


Teodorescu M.,James B Skatrud Pulmonary Sleep Research Laboratory | Teodorescu M.,University of Wisconsin - Madison | Xie A.,University of Wisconsin - Madison | Sorkness C.A.,University of Wisconsin - Madison | And 22 more authors.
Journal of Clinical Sleep Medicine | Year: 2014

Study Objective: Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness. Study design: 16-week single-arm study. Participants: 18 (14 females, mean [± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV 1 89 ± 8% predicted). Interventions: High dose (1,760 mcg/day) inhaled FP. Measurements: (1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure - Pmax, in KPa) and endurance - time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot) - at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects. Results: Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved. Conclusions: In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined. Source


Teodorescu M.,James B Skatrud Pulmonary Sleep Research Laboratory | Teodorescu M.,University of Wisconsin - Madison | Broytman O.,James B Skatrud Pulmonary Sleep Research Laboratory | Broytman O.,University of Wisconsin - Madison | And 9 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2015

BACKGROUND: Obstructive sleep apnea (OSA) may worsen asthma, but large studies are lacking and the underlying mechanisms are unknown. OBJECTIVE: The objective of this study was to determine the prevalence of OSA risk among patients with asthma of different severity compared with normal controls (NC), and among asthmatics, to test the relationship of OSA risk with asthma burden and airway inflammation. METHODS: Subjects with severe (SA, n = 94) and nonsevere asthma (NSA, n = 161), and NC (n = 146) were recruited in an add-on substudy, to the observational Severe Asthma Research Program (SARP) II; subjects completed sleep quality, sleepiness and OSA risk (Sleep Apnea scale of the Sleep Disorders Questionnaire [SA-SDQ]) questionnaires, and clinical assessments. Sputum was induced in a subset of asthmatics. RESULTS: Relative to NC, despite similar sleep duration, the subjects with SA and NSA had worse sleep quality, were sleepier, and had higher SA-SDQ scores. Among asthmatics, higher SA-SDQ was associated with increased asthma symptoms, ß-agonist use, health care utilization, and worse asthma quality of life. A significant association of SA-SDQ with sputum polymorphonuclear cells% was noted: each increase in SA-SDQ by its standard deviation (6.85 units) was associated with a rise in % sputum neutrophils of 7.78 (95% CI 2.33-13.22, P =.0006), independent of obesity and other confounders. CONCLUSIONS: OSA symptoms are more prevalent among asthmatics, in whom they are associated with higher disease burden. OSA risk is associated with a neutrophilic airway inflammation in asthma, which suggests that OSA may be an important contributor to the neutrophilic asthma. Further studies are necessary to confirm these findings and better understand the mechanistic underpinnings of this relationship. © 2015 American Academy of Allergy, Asthma & Immunology. Source

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