Frequency of obstructive sleep apnea in patients with asthma or allergic rhinitis: a systematic review and meta-analysis

Ferreira NB, Ponte A, Grande AC et al.  Sleep Med. 2025 Jul 30;134:106705. doi: 10.1016/j.sleep.2025.106705. 

Highlights

• Allergic rhinitis is associated with a higher frequency of obstructive sleep apnea (OSA).
• Asthma - particularly moderate-to-severe cases - shows an association with OSA.
• Prospective studies are needed to clarify causality and guide screening strategies.

Abstract

Background

Asthma and allergic rhinitis (AR) are prevalent respiratory diseases that often coexist with obstructive sleep apnea (OSA). The objective of this study was to evaluate whether asthma or AR are associated with a higher frequency of OSA.

Methods

We performed a systematic review including cross-sectional and cohort studies that evaluated adult participants with and without asthma or AR and reported OSA diagnosed via polysomnography. We searched PubMed, Web of Science, and Scopus. Risk of bias was assessed using the ROBINS-E tool. Certainty of evidence was evaluated using the GRADE Framework. A random-effects meta-analysis of odds ratios (OR) to quantify the association between asthma or AR and OSA was performed.

Results

Graphical Abstract

We included 12 studies (N = 19,203 participants). The meta-analysis indicated a higher frequency of OSA in AR patients (OR = 2.4; 95 %CI = 1.1; 5.3) compared to patients without the disease. In overall patients with asthma, the association with OSA (OR = 1.4; 95 %CI = 0.9; 2.2) was weaker than that observed in patients with moderate to severe asthma (OR = 10.1; 95 % CI = 1.3; 81.7).

Patients with asthma exhibited slightly higher apnea-hypopnea index and oxygen desaturation index, along with lower mean oxygen saturation, compared to patients without asthma.

Conclusions

This meta-analysis identified an association between AR or asthma (particularly moderate to severe asthma) and OSA. Future research should address risk assessment of OSA for asthma and AR patients through prospective cohort studies, controlling for referral bias and asthma severity.

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