Continuous positive airway pressure therapy suppresses inflammatory cytokines and improves glucocorticoid responsiveness in patients with obstructive sleep apnea and asthma: A case-control study

Bassam Mahboub; Zelal Kharaba; Rakhee K Ramakrishnan; Narjes Saheb Sharif Askari; Laila Ibraheem Salameh; Hassan Saber Alhariri; Mayank G Vats; Wafa Taleb Erabia; Esra'a Mohammad Alshawamreh; Yassen Alfoteih; Andrea K Mogas; Rabih Halwani; Qutayba Hamid

doi:10.4103/atm.atm_37_22

Continuous positive airway pressure therapy suppresses inflammatory cytokines and improves glucocorticoid responsiveness in patients with obstructive sleep apnea and asthma: A case-control study

Ann Thorac Med. 2022 Jul-Sep;17(3):166-172. doi: 10.4103/atm.atm_37_22. Epub 2022 Jul 9.

Authors

Bassam Mahboub^{1

2}, Zelal Kharaba^{3

4}, Rakhee K Ramakrishnan², Narjes Saheb Sharif Askari², Laila Ibraheem Salameh^{1

2}, Hassan Saber Alhariri¹, Mayank G Vats¹, Wafa Taleb Erabia¹, Esra'a Mohammad Alshawamreh¹, Yassen Alfoteih⁵, Andrea K Mogas⁶, Rabih Halwani², Qutayba Hamid^{2

6}

Affiliations

¹ Department of Respiratory and Sleep Medicine, Rashid Hospital, Dubai Health Authority, Dubai.
² Tissue Injury and Repair Research Group, Sharjah Institute for Medical Research - College of Medicine, University of Sharjah, Sharjah.
³ Department of Clinical Pharmacy, College of Pharmacy, Al-Ain University, Abu Dhabi.
⁴ School of Pharmacy, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom.
⁵ Department of Dental Surgery, City University College of Ajman, Ajman, United Arab Emirates.
⁶ Meakins Christie Laboratories, McGill University, Montreal, QC, Canada.

Abstract

Context: Asthma and obstructive sleep apnea (OSA) are prevalent respiratory disorders that frequently coexist. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA. However, its effects on systemic inflammation and glucocorticoid responsiveness in OSA patients with asthma are largely unknown.

Aims: To examine the potential role of CPAP therapy in reducing systemic inflammation and improving glucocorticoid responsiveness in asthmatic patients with OSA.

Settings and design: A case-control study was conducted at the respiratory and sleep clinics involving patients with OSA and patients with asthma and OSA.

Methods: The levels of inflammatory asthma biomarkers (interleukin [IL]-4, IL-17A, IL-8, IL-2, and interferon-γ [IFN-γ]), and glucocorticoid receptors (GR)-α and GR-β, were determined to compare systemic inflammation and glucocorticoid responsiveness between pre- and post-1-month CPAP treatment in both groups.

Statistical analysis: The Wilcoxon signed-rank test was used to compare inflammatory biomarkers before and after CPAP therapy. P < 0.05 considered statistically significant. The analysis was performed using SPSS.

Results: Recruited patients (n = 47), 51% (n = 24) had OSA and 49% (n = 23), had OSA with asthma. Interestingly, the blood levels of IL-17 and IL-8 were significantly decreased post-CPAP therapy in OSA patients, whereas IL-4, IL-17, and IFN-γ were significantly reduced post-CPAP treatment in OSA patients with asthma. Remarkably, CPAP therapy improved glucocorticoid responsiveness in asthmatic patients with OSA, but not in the OSA group and an increase in the GR-α/GR-β ratio was noted post-CPAP therapy.

Conclusions: Continuous positive airway pressure therapy improved responsiveness to glucocorticoid treatment and demonstrated a suppressive effect on proinflammatory cytokines in asthmatics with OSA.

Keywords: Asthma; continuous positive airway pressure (CPAP); cytokines; glucocorticoids; inflammation; inflammatory biomarkers; obstructive sleep apnea; systemic.