Relationship of nocturnal bronchoconstriction to sleep stages

The possible role of sleep stages in the pathogenesis of nocturnal asthmatic attacks is still under debate because previous studies suffered methodologic limitations that prevented the possibility of providing a clear-cut answer to the question. To evaluate the relationship of nocturnal asthma to sleep, eight asthmatics with unstable asthma (seven with history of nocturnal wheeze) and four reference subjects were submitted to all-night polysomnography, including the continuous evaluation of esophageal and supraglottic pressure (with two catheters) as well as of airflow (with a face mask), so as to derive total lung resistance, supraglottic resistance, and, by subtraction lower respiratory resistance (Rlr). Stage 3-4 was characterized by the highest peaks in Rlr and by longer episodes of bronchoconstriction; conversely, neither the onset nor the remission of the latter were specifically related to any sleep stage. Considering episodes remitted with an awakening. Stage 3-4 was marked by higher Rlr peaks than during REM sleep. We conclude that sleep plays a contributory role in the multifactorial pathogenesis of nocturnal asthma, with a higher susceptibility during slow-wave sleep, probably related to a decreased responsivity to resistive loads.