Study Links Asthma Medications to Increased Risk of Sleep Apnea

Inhaled corticosteroid medications used to treat asthma may increase the risk of sleep apnea, a new pilot study suggests. Dr. Mihaela Teodorescu, an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, in Madison and the director of the James B. Skatrud Pulmonary Sleep Research Laboratory at the Middleton Memorial Veterans Hospital, said that “Inhaled corticosteroids may predispose to sleep apnea in some asthma patients,” The findings were published in the February issue of the Journal of Clinical Sleep Medicine.

Sleep apnea is a potentially serious condition where breathing stops during sleep. It is most often caused by a collapsed or blocked airway, and can increase the risk of high blood pressure, heart attack and stroke if left untreated. Pauses in breathing can occur as often as 30 times per hour and can last from a few seconds to even minutes, according to the U.S. National Heart, Lung and Blood Institute.

The small study looked at 18 men and women who took 1,760 micrograms of inhaled Flovent (fluticasone) each day. Pulmicort (budesonide) is another inhaled corticosteroid. Researchers assessed tongue function and “collapsibility” of these patients’ upper airways. Three patients also had the amount of fat in their soft palate measured through MRI, which showed the fat relocated to the neck area; this can make the airway more narrow. All patients showed changes in the upper airway and tongue function consistent with sleep apnea, although some were more affected than others. The most vulnerable patients included men, patients in their mid-30s and older, and patients who had poorly controlled asthma from the beginning.

Teodorescu is continuing to study the medications for future research, where larger studies are anticipated. According to Dr. Len Horovitz, a pulmonologist and internist at Lenox Hill Hospital in New York City, it may be helpful to include evaluations by speech pathologist and ear-nose-throat specialists because features studied, floppiness of the tongue and oral membranes, would also be associated with speech and vocal quality changes.

Teodorescu said that patients should keep taking prescribed steroids if it helps them control their asthma. She said that the dosage and medicine should match each patient’s individuals needs, also added that “If people with asthma are told they snore, they should talk to their physician about the possibility of sleep apnea,”