TY - JOUR
T1 - Effects of Inhaled Fluticasone on Upper Airway during Sleep and Wakefulness in Asthma: A Pilot Study
AU - Teodorescu, Mihaela C.
AU - Xie, Ailiang
AU - Sorkness, Christine A.
AU - Robbins, Jo Anne
AU - Reeder, S. B.
AU - Gong, Yuanshen
AU - Fedie, Jessica E.
AU - Sexton, Ann
AU - Miller, Barbara
AU - Huard, Tiffany
AU - Hind, Jacqueline A.
AU - Bioty, Nora
AU - Peterson, Emily
AU - Kunselman, Susan J.
AU - Chinchilli, Vernon M.
AU - Soler, Xavier
AU - Ramsdell, Joe Wesley
AU - Loredo, José S.
AU - Israel, Elliot
AU - Eckert, Danny J.
AU - Malhotra, Atul
PY - 2014
Y1 - 2014
N2 - Study Objective: Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness. Study design: 16-week single-arm study. Participants: 18 (14 females, mean [± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV 1 89 ± 8% predicted). Interventions: High dose (1,760 mcg/day) inhaled FP. Measurements: (1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure - Pmax, in KPa) and endurance - time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot) - at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects. Results: Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved. Conclusions: In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined.
AB - Study Objective: Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness. Study design: 16-week single-arm study. Participants: 18 (14 females, mean [± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV 1 89 ± 8% predicted). Interventions: High dose (1,760 mcg/day) inhaled FP. Measurements: (1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure - Pmax, in KPa) and endurance - time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot) - at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects. Results: Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved. Conclusions: In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined.
KW - Asthma
KW - Genioglossus
KW - Inhaled corticosteroid
KW - Lung
KW - Obstructive
KW - Sleep apnea
UR - http://www.scopus.com/inward/record.url?scp=84894268120&partnerID=8YFLogxK
U2 - 10.5664/jcsm.3450
DO - 10.5664/jcsm.3450
M3 - Article
SN - 1550-9389
VL - 10
SP - 183
EP - 193
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 2
ER -