How Sleep Apnea Can Cause Asthma

You may be thinking that I’m stretching things a bit by suggesting that obstructive sleep apnea can cause asthma, but there are numerous published studies linking these two conditions. A recent study published in Chest showed that poorly controlled adult asthmatics had a much higher chance of having undiagnosed obstructive sleep apnea—almost 3 times higher.

Here are 3 ways that sleep apnea can aggravate or cause asthma:

1. It’s been shown that repeated apneas can cause a vacuum effect in the throat that can suction up your normal stomach juices into your throat. This “juice” contains not only acid, but also bile, digestive enzymes, and bacteria. Furthermore, these same juices can reach the nose, sinuses, ears and the lungs. Washings of these areas have demonstrated the presence of pepsin, one of the digestive enzymes, and H. pylori, a common stomach bacteria. Even small amounts of stomach juice in your lungs can definitely cause major inflammation.

2. Repeated obstructions and arousals can cause your involuntary nervous system to become hypersensitive to weather changes, such as temperature, humidity, and pressure changes. You can also be sensitive to chemicals, scents or odors. This condition in the nose is called nonallergic or chronic rhinitis. In the lungs, the equivalent is probably what we call reactive airway disease. Allergists and asthma researchers have stated that the nose and lungs are essentially one airway, and have coined the phrase, “one airway, one disease.”

3. If you’ve ever experienced dirt or dust in one of your eyes, the you’ll tear in the other eye as well. Similarly, if your nose is irritated, then by applying the concept of “one airway, one disease,” your lungs will become inflamed. Conversely, if you place some stomach acid in your lungs, then your nose will automatically become inflamed through this reflexive process. Having a stuffy nose can create a vacuum effect downstream, promoting even more frequent tongue collapse, leading to more obstructions, and to more reflex episodes.

How many of you with obstructive sleep apnea also have asthma?

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10 thoughts on “How Sleep Apnea Can Cause Asthma

  1. Hi Dr. Park,

    Thank you for your insightful comments. I had difficult to control asthma for several years until my apnea was treated. I noticed that when I was exposed to my triggers, I would have a bad night’s sleep. I noticed that I became very sensitive to certain fragrances, odors and pet danders. After treatment with surgery and a bipap, I am not longer as sensitive and discontinued daily use of asthma medications.

  2. I will never see medicine in the same light again. now I am seeing the studies on how exposure to rhinovirus in infancy increases the risk of asthma later in life. and all I can think is, well, the congestion from the rhinovirus causes obstruction with some episodes of OSA that lead to LPRD and the acid gets into the lungs and so is this why viruses make kids wheeze? or at least a major contributor. and so is it the tendency to have OSA with your cold really the predicting factor for asthma? is this why asthma is worse at night? is this why croup is worse at night, as opposed to the gravity theory? maybe the kids who are prone to croup are prone because of their tendency to LPRD/OSA as much as they are prone because of a smaller larynx? is this why a cough with a cold is worse at night, in addition to the post nasal drip issue? I definitely understand the GERD-asthma connection better now, but could it be that the LPRD desensitizes the LES such that it does not function normally anymore and then you have GERD?

    my asthma started at the same time my MCS started to get worse, and I have thought it was Lysol that got it started, but now I realize my UARS got worse at the same time, and it’s probably the UARS that has caused both the MCS and the asthma. my inspiratory chest pain at night that I have blamed on asthma went away with treatment for my UARS, so now I know the chest pain is probably from acid in my tracheobronchial tree.

  3. and is this the reason why kids with asthma always flare when they have an ear or sinus infection? how will I function if I go back to practice and I’m wanting to send the toddler with recurrent ear infections for a sleep study?

  4. Dr. Deb,

    You’re definitely on a roll making all the connections. In fact, a pulmonologist/sleep doctor did agree with me recently that the chronic atelectaisis that’s seen in the distal bronchial tree may be due to reflux.

    I also think that second hand smoke acts as a major irritant to the upper airway, causing inflammation and narrowing of the nose, aggravating further obstructions reflux, and arousals. It’s important to note that these obstructions don’t necessarily have to be apneas.

    Anything that causes inflammation in the upper airway, from allergies to weather changes, to what you just ate, and even your emotions, can affect the caliber of your breathing passageways.

    This is also why hospitalized patients have so much more bronchitis and pneumonias during admission. People with undiagnosed obstructive sleep apnea or UARS (more likely to be hospitalized to begin with) are forced to sleep on their backs, and tethered with wires and tubing which prevents then from rolling over to their side or stomach. I also blogged in the past about why inpatients tend to have heart attacks at much higher rates from 3-6 AM (when they’re in REM sleep and they’re sleeping supine).

  5. I am also wondering if the recent press about cold medications and telling us not to use them for young children has done anything to the incidence of bacterial URIs and asthma? you would think that a decongestant at night would help prevent the LPRD, so the incidence might be on the rise. I have always been against cold meds for infants under 6 months, but with what I know now I won’t let my 3 yr old with a cold go to sleep without his Dimetapp.

  6. dr park i don’t know if you can help me or not but i’ve had every pulmonary test and they say i havea slight case of asthma But i still have trouble breathing i also have sleep anpea rest less leg syndome thyroid trouble high cholesterol swelling in both feet ankles and acid reflux and i’m a little over weight the doctors does’nt seem to be to concern about my breathing all they seem to be concern about is my weight they havemade me feel like the trouble withmy breathing is all in my head if you have any information for me let know please

  7. Please help! my daughter sent for all test to diagnose asthma and they all came back negative for athma. Around the same time she was diagnosed with sleep apnea at 8 years old. today she woke and couldnt breath. the doctor at the clinic said she most definately has athma. im so confused and concernd. is there something else it coulod be?

  8. I am a retired cardiac surgeon who has Sleep Apnea diagnosed about 3 years ago. I have been using a CPAP machione since then.

    Are there any paper or studies on Reactive Airway Disease (RAD) as a result of the use CPAP machines for Sleep Apnea?

    Please email me a link to the article if you found one.

    Thank you and best wishes.


  9. I have been using a cpap for about a year. Have never had asthma. But since been using have notice big difference in my air way and breathing during the day. I’m very concerned. Makes since though my body is dependent on air during the night so mow I feel I’m struggling during the day. So I’m assuming because of dependence on machine at night this has caused another issue for me should o consult my doctor??