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Can Asthma Cause Sleep Apnea

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Relationship Between Asthma And Obesity

Asthma and Obstructive Sleep Apnea

Obesity represents a major risk factor and a disease modifier of asthma both in children and adults . It was found that obese subjects have increased risk of asthma and obese asthmatics have more symptoms, more frequent and severe exacerbations, a reduced response to medications and an overall decreased quality of life highlighting a bidirectional correlation between these two entities. There are likely different phenotypes within the obese asthma syndrome: those seen in lean individuals complicated by obesity, disease newly arising in obese individuals and phenotypes worsens by increased environmental pollutants response . Different factors contributing to the syndrome of obesity-related asthma have been hypothesized such as diet, the microbiome, genetic factors, metabolic and immune function , environmental exposures and mechanical effects: reduction in functional residual capacity and expiratory reserve volume . As obese asthma syndrome is a complex and multifactorial entity which is just beginning to be understood further studies should better characterize this disease to understand, in particular, mechanisms conducting to the phenotype of severe and uncontrolled asthma.

Can A Cpap Machine Help Asthma

Yesa CPAP machine can help relieve asthma symptoms, in addition to OSA. Ultimately, this is because the two conditions are tied so closely together.

One study suggests that using a CPAP machine can help to improve lung function, asthma control, and the quality of life for those with both asthma and OSA. However, it will not cure your asthma condition.

Who Has Sleep Apnea

More than 18 million American adults have sleep apnea, according to the National Sleep Foundation. It can occur in children. African-Americans, Hispanics and Pacific Islanders are at greater risk.

People with asthma are at increased risk of developing sleep apnea. Being overweight, smoking and alcohol use are also risk factors. Sleep apnea also tends to run in families. In some cases, it results from body structure having a small upper airway, for example, or a recessed chin, small jaw or large neck size.

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Calculating Your Combined Rating

If you can provide a medical nexus that proves you suffer from both conditions and you can link it to your time in the military, you could combine your two ratings to improve your payout. While it sounds simple in theory, doing so doesnt mean just adding your two ratings together. For instance, if you qualify for a 30% rating for asthma and a 50% rating for sleep apnea, you cant add them together for an 80% rating.

Rather, youll start with your highest rating, and locate that number on the left-hand column of the VA Combined Ratings Table. Then, follow the row across to your second-highest rating. Youll find a percentage where these two numbers intersect, and that is your new, combined rating. 

Using the VA Combined Ratings Table, lets take a look at the example above.

Well start with the highest rating, which is 50% for sleep apnea. Then, well go across to the 30% rating at the top. The new, combined rating is 65%. It rounds to the nearest 10, so that would give you a 70% rating. 

What Is The Va Rating For Sleep Apnea

Does asthma have something to do with sleep apnea?

The VA rates sleep apnea under 38 CFR ยง 4.97, Diagnostic Code 6847.

This code is designated to cover all sleep apnea syndromes, including those associated with the obstructive, central, and mixed forms of the condition. 

We go into greater detail about VA disability ratings for sleep apnea in this post. Here, well just hit the highlights.

Depending on the severity of your condition, the VA can assign a rating of 0%, 30%, 50% or 100% to your condition. Lets take a look at the breakdown:

  • 0% Rating: You have a documented sleep disorder, but you are not exhibiting any symptoms . 
  • 30% Rating: Youre experiencing chronic daytime sleepiness , regardless of how much sleep you get.
  • 50% Rating: You require the use of a breathing assistance device to sleep at night. 
  • 100% Rating: Your sleep apnea has resulted in chronic respiratory failure with carbon dioxide retention. You can also receive this rating if you require a tracheostomy to alleviate your symptoms. 

While it is possible, a 100% rating for sleep apnea is relatively rare and is only assigned in the event of very severe symptoms. A tracheostomy is a surgically-created hole made in your windpipe to serve as an alternate airway for breathing.  

Here one of our VA disability lawyers talks about sleep apnea VA disability ratings.

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Is There A Link Between Asthma & Sleep Apnea

The Wisconsin Sleep Cohort Study did a long-term tracking of roughly 550 men and women. Of the participants, about 15% of participants reported they suffered from asthma. Since 1988, participants were contacted every four years to do a follow-up health questionnaire and overnight, in-lab sleep study . 

In the first follow up visit, the study found that about 27% of those with asthma had newly developed cases of sleep apnea. This was a staggering percentage as only 16% of non-asthma patients developed OSA. Over the course of the entire study, researchers realized that asthma sufferers were at a 40% greater risk of developing sleep apnea than those without asthma. Even more alarming was that, the longer someone suffered from asthma, the more likely they were to develop OSA. 

While its important to note that the study was able to make a clear, definable association between asthma and sleep apnea sufferers, it did not yield strong enough results to point to a cause/effect relationship between the two disorders. 

What You Need To Know About Asthma And Sleep Apnea

  • May 14, 2020

Medically Reviewed by Dr. Monique May

You may think of asthma and sleep apnea as two unrelated conditions.  Asthma typically occurs during the day, such as after someone is exposed to a trigger or after a sporting event, and sleep apnea occurs of course only at night . 

However, it may come as a surprise that asthma and sleep apnea are actually related. Both are lung conditions that may have an impact on your body both day and night. They also can contribute to and worsen each other. So, how exactly are they connected, and what should you do if youre at risk?

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Preventing Sleep Apnea And Asthma

In order to do your part towards claiming your life back from sleep apnea and asthma, it is very important to actively manage these conditions. Take your medicine as directed and use your CPAP machine every single night. You should get a minimum of six to eight hours of sleep per night.

Engage in just a few lifestyle changes to improve your overall health.

For example, watch what you eat. Reduce your intake of sugar, carbs, and junk food and instead opt for healthier options like fruit, veggies, nuts , seeds, and whole grains to reduce your weight.

Also, engage in moderate exercise at least three times a week by taking a brisk walk, going for a swim, cycling, or using an elliptical to burn fat, build muscle and strong bones, and reduce stress.

What You Can Do To Improve Sleep

Sleep on It – Asthma Tied to Sleep Breathing Problems

There are several steps you can take in order to sleep better. The first step is to make sure that your asthma is under good control. You may have to visit with your health care provider to be evaluated. This will help to insure that you are getting the right medical treatment. You can then develop a series of steps to take, to control your asthma and guide you through an episode of sudden breathlessness.

Your provider will instruct you when to use your rescue inhaler or pursed lip breathing, and what questions to ask yourself about your condition, should you experience any sudden breathlessness. Also, talk to your health care provider if you have nasal congestion or get heartburn, to get them under better control. If you smoke, quitting smoking will not only help your asthma, but the quality of your sleep will also improve. Tell your health care provider if you think you may have sleep apnea so that you can be evaluated. Sleep apnea is a treatable condition!

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Symptoms Of Asthma May Contribute To Sleep Apnea

Response from Lyn Harper, MPA, BSRT, RRT:

Different studies have definitely shown a link between asthma, sleep apnea, and snoring. First of all, if you suffer from asthma, you know that if its not well controlled, and even sometimes when it is, you wake up at night with difficulty breathing. You may be wheezing and your chest feels very tight.

In addition, these same studies suggest that people with asthma are at increased risk to develop sleep apnea. Sleep apnea can cause increased inflammation in the airways a problem that can trigger irritation and constriction of the small airways, leading to worsening asthma. Many people with sleep apnea complain of nasal congestion which can also contribute to snoring and an exacerbation of asthma.

Since sleep is essential for a good quality of life, its very important to find the underlying cause for wakefulness at night. If its asthma, find out the triggers. Rid your bedroom of upholstery, pet dander, dust mites, and any other allergens that may cause worsening asthma at night.

Be vigilant about taking medications as prescribed. If you suspect you have sleep apnea, speak to your doctor about it. He or she may recommend you have a sleep study. Sleep apnea can become worse if we carry extra weight around, so try to maintain a healthy weight by a good diet and regular exercise.

How Asthma Contributes To Sleep Apnea

While asthma is normally viewed as a condition that takes place during the day time, symptoms can certainly worsen during the night. When nocturnal asthma occurs, the airways struggle to pull enough oxygen into the lungs and this may cause attacks of coughing, chest tightness, shortness of breath, and wheezing during sleep. As a result, over time the airways may become inflamed and restricted.

You may or may not wake up completely from nocturnal asthma, but as your body fights to restore normal airflow, these interruptions disrupt your normal sleep and prevent your body from getting necessary oxygen and proper rest, very similar to how sleep apnea disrupts restful sleep.  They both can lead to fatigue and poor concentration.

Because severe asthma can cause periods of apnea, or moments during sleep when you stop breathing, it can contribute to low oxygen levels, sleep deprivation, high blood pressure, diabetes, stroke, heart attacks, weight gain, depression, and much more.

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Talk To Your Doctor About Asthma And Sleep Apnea

Response from Theresa Cannizzarro, Respiratory Therapist:

There is a ton of evidence that sleep apnea can aggravate asthma symptoms. Obstructive sleep apnea occurs when the upper airway closes during sleep which causes the reduction of airflow and oxygen to the lungs. You may snore, cough, or wake up gasping for air numerous times per night.

You may not realize you are waking up due to sleep apnea. This may lead to increased inflammation in the body, including the lungs. Narrowing of the small airways can lead to more irritation and constriction of the smooth muscle in the lungs, which makes asthma symptoms worse. If you suspect you have sleep apnea definitely talk with your doctor about it so they can order a sleep study to test to see if you, in fact, have sleep apnea.

Clinical Outcome Of Asthma

Can asthma cause sleep apnea Staten Island

Not only does OSA seem to be associated with development of nocturnal asthma, it is also associated with persistent daytime asthma symptoms, particularly in those with severe and difficult-to-treat asthma. Thus, unrecognized OSA may be the cause of persistent daytime and nocturnal asthma .

There is still little evidence on the impact of OSA on asthmatic patients pulmonary function. Based on a 15-year follow-up study of ventilatory function in asthmatic patients, the unadjusted decline in forced expiratory volume in one second was 38 ml/year . There are several factors identified for the decline of FEV1 in asthma, including age, sex, asthma exacerbation, smoking status, obesity, and hypoxia . In a recent retrospective study, asthmatic patients with OSA were followed for more than 5 years with spirometry and showed a greater decline in FEV1 compared to those without OSA . In this study, the decline of FEV1 among asthmatic patients with severe OSA was 72.4 ml/year compared to 41.9 ml/year in those with mild to moderate OSA and 24.3 ml/year in those without OSA. After adjusting for confounder, OSA severity was the only independent factor affecting pulmonary function decline . However, in another recent meta-analysis, no significant difference of FEV1 was seen between asthmatic patients with and without OSA . Larger prospective studies are needed to verify long-term effects on pulmonary function.

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Thoughts On How Sleep Apnea Can Cause Asthma

  • MARIE

    Hi Dr. Park,

    Thank you for your insightful comments. I had difficult to control asthma for several years until my apnea was treated. I noticed that when I was exposed to my triggers, I would have a bad nights sleep. I noticed that I became very sensitive to certain fragrances, odors and pet danders. After treatment with surgery and a bipap, I am not longer as sensitive and discontinued daily use of asthma medications.

  • Dr. Deb

    and is this the reason why kids with asthma always flare when they have an ear or sinus infection? how will I function if I go back to practice and Im wanting to send the toddler with recurrent ear infections for a sleep study?

  • Dr. Deb

    I am also wondering if the recent press about cold medications and telling us not to use them for young children has done anything to the incidence of bacterial URIs and asthma? you would think that a decongestant at night would help prevent the LPRD, so the incidence might be on the rise. I have always been against cold meds for infants under 6 months, but with what I know now I wont let my 3 yr old with a cold go to sleep without his Dimetapp.

  • liz

    do you have information on breathing troubles that could help me

  • How Is Sleep Apnea Treated

    Doctors may first recommend lifestyle changes such as avoiding alcohol, quitting smoking and/or losing weight. You may need to stop taking any medications that relax the central nervous system sedatives or muscle relaxers, for example. Some patients may benefit from special pillows that help them sleep on their side instead of their back.

    The primary treatment for sleep apnea is CPAP continuous positive airway pressure. The patient attaches a face mask that is attached to a tube and respiratory machine that blows pressurized air into the mask and through the airways during sleep. This helps keep the airways open.

    Secondary treatments may include:

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    Va Files Joint Motion For Remand With The Veterans Representative

    Following the Boards denial, both parties filed for Joint Motion for Remand as they agreed the Board had failed to provide adequate reasons or bases for finding that aggravation means that the disability permanently worsened beyond its natural progression.  In August of 2017, the Court of Appeals for Veterans Claims granted JMR and remanded the matter.  Subsequently, on September 7, 2017, the Board informed the Veteran, and his previous representative, that he may submit additional argument and evidence.  The Board further noted that all evidence and argument must be submitted within 90 days of the date of this letter or until the date the Board issues a decision in appeal, whichever comes first.  However, on September 19, 2017, CCK informed the Board that the firm was recently appointed as the Veterans representative before VA.  CCK also requested a copy of the 90-day letter, if one had already been mailed, and requested that the Board not issue a decision before the end of the 90-day period as there was additional argument and evidence to submit.  Nonetheless, the Board denied entitlement to compensation for obstructive sleep apnea as secondary to asthma on November 8, 2017, prior to the expiration of the 90-day period.

    Secondary Service Connection For Sleep Apnea

    Thunderstorms Can Affect Sleep, Apnea, Asthma, Emphysema

    A secondary service-connected disability is one that results from a condition that is already service-connected.  In claims for secondary service connection, proving a medical nexus is especially important.  With regard to the conditions discussed herein, veterans may be eligible for service connection on a secondary basis for sleep apnea.  That is, if a veteran is service-connected for asthma and later develops sleep apnea, they should subsequently be service-connected for the sleep apnea if they can provide the appropriate medical evidence.

    To apply for secondary service connection for sleep apnea, veterans can file a claim the same way they would file an initial claim for service-connected compensation.  They will need to demonstrate the following to VA to be granted secondary service connection for sleep apnea:

    • A diagnosis of sleep apnea
    • Medical evidence showing the relationship between their service-connected asthma and their sleep apnea

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    Links Between Asthma And Sleep Apnea

    Many studies have now shown that people who have asthma are more likely to develop obstructive sleep apnea. This risk is almost 40% greater for them than for people with no asthma. Some of this is due to the use of systemic steroids in treating asthma. Long-term use of these steroids can cause upper airway muscles to weaken which may result in impaired function. This issue is directly related to obstructive sleep apnea. When throat muscles have weakened because of asthma, the tendency for the throat to collapse and obstruct the airway increases. 

    Because of this the longer a veteran has asthma the higher the likelihood is that they will develop sleep apnea.

    Cck Argues And The Court Agrees

    CCK argued the Board erred by relying on VA medical opinions that were inadequate overall.  However, VA argued that CCK was precluded from arguing this because the previous JMR only mentioned inadequacies based on permanent worsening.  The Court agreed with CCK: the terms of the JMR did not relieve the Board of its duty to address and provide adequate reasons or bases regarding the adequacy of the August 2013, June 2016, and July 2016 VA medical opinions, and CCK is not precluded from now raising arguments concerning these opinions on the Veterans behalf.  VA also maintained the Court should decline to address CCKs arguments concerning the adequacy of the VA medical opinions because they should have been raised previously.  Again, the Court agreed with CCK, affirming that CCK requested that the Board not issue a decision before the 90-day period to submit additional evidence and argument expired.  Since the Board issued its decision prior to the expiration of the 90-day period, the Court did not preclude CCK from raising arguments now.  Accordingly, the Veterans case was remanded back to the Board.

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    Recognizing The Impact Of Obstructive Sleep Apnea In Patients With Asthma

    Abstract: The coexistence of asthma and obstructive sleep apnea in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure . Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient’s asthma regimen. :423-435)

    Obstructive sleep apnea and asthma are both common medical problems.1,2 It is estimated that up to 40 million persons in the United States have OSA, while 17 million have asthma.1-4 Moreover, OSA and asthma may coexist,5 further complicating airway inflammatory pathology and the management of airway disease.

    In this article, we will discuss the association between OSA and asthma and the role of certain comorbidities, such as obesity, gastroesophageal reflux disease , nasal obstruction, and rhinosinusitis, that may complicate either or both diseases.

    Obesity

    Is There A Link Between Gerd And Sleep Apnea

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    Whats the connection between GERD and sleep apnea? Anyone who suffers from GERD can confirm that it affects sleep. Theres nothing like waking during the night choking on caustic stomach acid to ruin a good nights sleep.

    But then, pets, kids, the phone, and many other things can interfere with your comfortable sleep, too, so we must note that GERD and sleep apnea are connected in a kind of chicken and egg relationship.

    Its unclear whether one of the two leads to the other or if their co-occurrence is a mere coincidence. However, there is a significant difference between the two.

    If GERD burns the back of the throat, but sleep apnea causes the trachea to over-relax, it would seem the two are opposites, not complements. Yet, some researchers suspect that there is a causal link between GERD and OSA.

    Most people with sleep apnea have OSA. But, is there a genuine connection between the two conditions? Investigations of OSAs comorbidity with GERD and various other health concerns are ongoing.

    Are GERD and sleep apnea related? Given the amount of comorbidity to account for, we might never know for sure.

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    Asthma And Sleep Apnea : Hand

        Researchers are puzzled as to why there seems to be a significant rise on rates of asthma in children compared to previous years. A study released from the CDC reported that nearly one in 10 children and one in 12 Americans have asthma. From 2001 to 2009, the overall rate of asthma increased 12.3%. In 2013, it cost $57 billion to care for asthma patients.

       Despite lower rates of smoking and second-hand smoke, the prevalence of asthma increased in all demographic groups, including men, women, whites, blacks, and Hispanics. Possible reasons for this sudden increase include various allergens, traffic fumes, pesticides, certain plastics, diet and obesity.

        Heres one more possibility: Obstructive sleep apnea. We know that children arekids with asthma more overweight than ever, and along with this its expected that sleep apnea will increase as well. Multiple breathing pauses at night can literally suction up your stomach juices into your throat, which can then reach your nose or your lungs. This causes your nose and your lungs to become inflamed and over-reactive to allergies, fumes, and even weather changes.

        Lack of deep sleep also causes your nervous system and your immune system to become hypersensitive, aggravating this vicious cycle.

        Having an asthma attack in the middle of the night can be a frightening and terrifying experience. Typically, these attacks happen in the early morning hours, just before awakening. 

      How Sleep Apnea Contributes To Asthma

      When sleep apnea causes you to stop breathing during the night, your body reacts by raising your heart rate and blood pressure, which can result in tossing and turning.  There may also be the backward flow of stomach acid into the esophagus , which can then irritate the lungs if it gets sucked into the throat and airways. This is one reason why it is important to not eat within two to three hours of going to bed, since reflux is less likely to happen on an empty stomach.

      As acid reflux burns your throat and airways the lungs may become inflamed, making it more difficult to draw in oxygen. This may also lead to your lungs being overly sensitive and reactive to allergens, fumes, and weather changes, and could result in worsening asthmatic symptoms. It may even lead to uncontrolled asthma that requires more doses of daily and rescue medicines, and that can result in scarring and damage of the lungs.

      Sleep deprivation contributes to hypersensitivity to common triggers and can weaken the immune system, creating a cycle of inadequate sleep and poor health.  Sleep apnea can also cause people to wake up with dry mouth, headache, irritability, and feelings of fatigue.

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