Effects of Inhaled Corticosteroids and Particle Size on Risk of Obstructive Sleep Apnea: A Large Retrospective Cohort Study

Maria Paula Henao, Jennifer L. Kraschnewski, Matthew D. Bolton, Faoud Ishmael and Timothy Craig
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Maria Paula Henao: Division of Allergy, Asthma, and Immunology, Penn State Hershey Medical Center, Hershey, PA 17033, USA
Jennifer L. Kraschnewski: Department of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, USA
Matthew D. Bolton: Bioinformatics and Enterprise Information Management, Penn State Hershey Medical Center, Hershey, PA 17033, USA
Faoud Ishmael: Division of Allergy, Asthma, and Immunology, Penn State Hershey Medical Center, Hershey, PA 17033, USA
Timothy Craig: Division of Allergy, Asthma, and Immunology, Penn State Hershey Medical Center, Hershey, PA 17033, USA

IJERPH, 2020, vol. 17, issue 19, 1-9

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.

Keywords: inhaled corticosteroids; asthma; obstructive sleep apnea; particle size of inhaled corticosteroids; mass median aerodynamic diameter; localized pharyngeal side effects; pharyngeal muscles (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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