Nighttime asthma is primarily a synchronized with sleep rhythm of daily changes in the bronchial caliber.
At Delhi University, 30 young people with clinically stable asthma were screened to determine the nature of sleep disturbance in this group of patients. The control group was made up of 30 healthy people. The study was conducted using a sleep diary, which was to be filled out by the subjects within a week. The results of the study showed that 90% of patients with bronchial asthma, compared to 27% in the control group have sleep disturbances. This difference is statistically significant. Another similar study conducted in the US also showed that asthma attacks, especially at night, lead to sleep disturbances and affect mental and physical performance.
Night–time asthma continues to be a serious problem for most patients and doctors. Nightly bronchospasm is a sign of inadequate asthma treatment, and its development requires special monitoring and urgent treatment. Additional treatment for night–time bronchospasm should be provided only when the best daytime therapy does not help to reduce night–time symptoms. Inhalation –agonists are currently recommended for the treatment and prevention of night–time asthma. For example, the drug serum (salmeterol), which lasts more than 12 hours after inhalation. There is already evidence that salmeterol improves symptoms, night–time pycfluometry, and sleep quality in night–time asthma. Formoterol is another long–lasting inhalation agent that has been shown to improve lung function overnight and the patient’s subjective impression of sleep quality.
As for the treatment of sleep disorders that occur in patients with night–time asthma, most researchers tend to believe that adequate treatment of asthma itself leads to the disappearance of sleep disorders in most cases. In cases where this is not the case, that is, sleep disorders begin to become chronic, it is necessary to select adequate treatment for sleep disorders that should not affect respiratory function. In particular, such therapy may include the use of a nonrenzodiazepine–type sleeping pills called iwadal (zolpidem), the efficacy and good compatibility with bronchodilators of which was shown in a recent study in St. Petersburg.
In cases where nighttime asthma is accompanied by sleep apnea syndrome, patients need special therapy with constant positive pressure in the upper respiratory tract, the so–called CPAR–therapy*, carried out with the help of special equipment.
Our study was carried out on the basis of Municipal Clinical Hospital No. 50 and Municipal Clinical Hospital No. 81 New York City south bronx with the help of the computerized diagnostic system for sleep polygraphic study – sleep laboratory During an asthma attack, the airways in your lungs get swollen and your chest feels tight. You may cough, wheeze or have trouble breathing. This happens when your lungs are exposed to a trigger, such as dust. The swelling in your lungs can occur slowly, and you may not realize it is happening.
The study involved 14 patients with AD – 11 women and three men, the average age of whom was 57.4 years. The overwhelming majority of patients had concomitant pathology: 10 patients had chronic bronchitis, 8 patients had arterial hypertension, 4 patients had CHD, and 2 patients had diabetes mellitus. The severity of the condition was estimated by clinical data, pycfluometry data, external respiration function and polysomnographic study results. Acute exacerbation of AD of medium severity was revealed in 3 patients, 11 patients had severe exacerbation, and 6 of them were admitted to the intensive care unit on admission to the hospital. Nine patients had frequent (more often than once a week) night–time attacks of bronchospasm, 3 patients – more often than twice a month, 2 patients – less than twice a month. Among the main complaints 9 patients noted the feeling of asphyxiation, 8 – coughing attacks, 7 – day drowsiness, 7 – feeling of tension, 6 – frequent nocturnal awakening. In the first 7 days after admission to the hospital, all patients underwent a polysomnographic examination.
According to our data, patients with AD showed a decrease in sleep efficacy up to 71.2% (at the rate of 93%), increase in EEG–activation reactions up to 84.1 events per hour (at the rate up to 21) and decrease in REM–stage of sleep up to 13.24% (at the rate of 20%). In addition, the data was obtained that the average SaO2 value in the subjects was equal to 90.6% (at the rate of at least 93%), and saturation decreased to a maximum of 45%, which confirms the data obtained in Western Europe on the presence of chronic hypoxia in this category of patients.
After the first polysomnographic study conducted during the period of asthma exacerbation, patients were prescribed adequate treatment of the underlying disease. Initially, they were injected with prednisolone once, in/in, in jets, then for one week patients took berodual 15–20 drops four times a day with the help of a nebulizer. In most cases, the normalization of the patient’s condition and disappeared sleep disorders. Under the influence of treatment, 9 patients had no feeling of tension, night awakening became less frequent, and daytime sleepiness decreased. According to this polysomnographic study, the duration of REM–stage sleep increased by an average of 18.5%. In addition, the night saturation of O2 increased in 7 patients to an average of 92.5%, i.e. almost to the normal value. The remaining 5 patients, who still had complaints about sleep disturbance during the normalization of the general state, were prescribed a preparation of melaxen (melatonin), which is a synthetic analogue of the epiphysis hormone melatonin. The drug was administered in a dose of 3 mg once a night for 30 days. After the course of administration of the preparation all patients had reduced the period of sleeping on the average to 15,4 minutes, increased the efficiency of sleep up to 78–85% and representation of REM–stage of sleep up to 17,9%. Thus, the preparation of melaxen can be recognized as safe and effective enough to combat sleep disorders in patients with bronchial asthma.
Night–time bronchial asthma is a rather serious problem from both medical and socio–economic points of view. The search for new methods to diagnose and treat this condition should lead to an improvement in the prognosis of the disease and the quality of life of a large number of patients suffering from this pathology.
Studies comparing the efficacy of long–lasting inhalable –agonists and other night–time asthma control agents have been relatively limited. One such study showed no significant difference in efficacy between salmeterol and ingested theophylline, although there were some marginal benefits of salmeterol in terms of wake–up frequency and improved quality of life. Another study found that salmeterol caused less impairment in lung function at night than theophylline and improved subjective sleep quality. Salmeterol also has an advantage over the slow release of terbutaline taken orally in terms of the number of nights when patients sleep safely until morning without waking up, as well as morning peak flow rates and clinical efficacy. Salmeterol, in a dose of 50 mg twice a day, has been as effective in improving patients‘ well–being in night–time asthma as fluticasone, which is used 250 mg twice a day. It is likely that inhalation long–lasting bronchodilators will gradually displace the long–acting bronchodilators, which are taken orally and have a large number of side effects.