Association between lung function decline and obstructive sleep apnoea: the ALEC study

Emilsson, Össur Ingi; Sundbom, Fredrik; Ljunggren, Mirjam; Benediktsdóttir, Bryndís; García Aymerich, Judith; Bui, Dinh Son; Jarvis, Deborah; Olin, Anna-Carin; Franklin, Karl; Demoly, Pascal; Lindberg, Eva; Janson, Christer; Aspelund, Thor; Gislason, Thorarinn

doi:http://dx.doi.org/10.1007/s11325-020-02086-1

Association between lung function decline and obstructive sleep apnoea: the ALEC study

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Emilsson ÖI, Sundbom F, Ljunggren M, Benediktsdottir B, Garcia-Aymerich J, Bui DS, Jarvis D, Olin AC, Franklin KA, Demoly P, Lindberg E, Janson C, Aspelund T, Gislason T. Association between lung function decline and obstructive sleep apnoea: the ALEC study. Sleep Breath. 2021 Jun;25(2):587-96. DOI: 10.1007/s11325-020-02086-1

Abstract

Purpose: To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship. Methods: We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor's diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up. Results: Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = - 41.3 ± 24.3 ml/year vs - 50.8 ± 30.1 ml/year; FVC = - 30.5 ± 31.2 ml/year vs - 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics. Conclusion: In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics.