Adults with both asthma and obstructive sleep apnea had a 62% higher risk of intubation compared with those with asthma alone., according to a recent study. In the large propensity-matched cohort analysis, researchers found that these adults also experienced significantly higher rates of respiratory and cardiovascular complications over 5 years compared with those who had asthma alone.

Patients with obstructive sleep apnea (OSA) had greater incidences of:

• asthma exacerbations—16.2% vs 12.5% of patients without OSA, with a relative risk of 1.30

• acute coronary syndromes—3.5% vs 2.6%, with a relative risk of 1.35

• atrial fibrillation—6.1% vs 4.2%, with a relative risk of 1.45

• all-cause intubation—2.1% vs 1.3%, with a relative risk of 1.62.

The researchers also reported increased bronchodilator and corticosteroid use among those with obstructive sleep apnea. The relative risk of 1.24 suggested greater disease burden and treatment intensity. 

The researchers leveraged the TriNetX electronic health records network to evaluate long-term outcomes across 69 US health care organizations between 2004 and 2024. Two adult cohorts were identified: patients with asthma but no OSA and those with both conditions. Asthma was defined by ICD-10 codes J45.xxx, and OSA was determined using diagnostic or procedure codes for obstructive sleep apnea or positive airway pressure therapy.

To minimize confounding, the investigators applied propensity score matching to balance baseline characteristics, including age, obesity, hypertension, and gastroesophageal reflux disease. Before matching, more than 6 million patients had asthma alone, while 697,287 had both asthma and OSA. After propensity score matching, each cohort included 638,474 patients with similar demographic and clinical profiles. The 5-year follow-up period began 1 day after the first asthma diagnosis. "Our results highlight the importance of multidisciplinary collaboration among pulmonary, sleep medicine, and cardiology services to optimize patient-centered care," the authors wrote in their abstract presented at CHEST 2025. "Clinicians should incorporate routine assessment for sleep-disordered breathing in asthma management protocols, especially in individuals with poorly controlled symptoms, obesity, or concurrent cardiovascular comorbidities," they added.

Tariq J Cheema reported honoraria from GSK, Boehringer Ingelheim, AstraZeneca, Regeneron, and Sanofi. All other researchers reported no relevant financial relationships.

Source: Chest Annual Meeting 2025