Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms

Abstract

Background The co‐existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In this study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients. Methods Forty‐five COPD patients (mean FEV1 1671.3 ± 532.0 mL) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7 ± 8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed. Results Twenty‐six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n = 26) and COPD without OSA (n = 19) groups were compared, BMI (29.6 ± 6.6 vs 25.6 ± 4.9 kg/m2; P = 0.03), TNF‐α level (24.8 ± 8.1 vs 3.6 ± 0.8 ng/mL; P = 0.03) and sleep time with SpO2 < 90% (23.9 ± 29.4 vs 9.7 ± 21.9%; P = 0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (P < 0.01), Epworth score (P = 0.050), COPD exacerbation frequency (P = 0.046) and TNF‐α (P = 0.048). However, multivariate linear regression analysis revealed a significant correlation only between RDI and BMI (P < 0.01). BMI as a predictor of OSA was examined through ROC curve analysis and the area under curve was 0.691 (P = 0.03). To identify OS patients, BMI > 27.2 kg/m2 had a sensitivity of 73% and specificity of 68%. Conclusions This findings support that high prevalence (58%) of OS in COPD patients without OSA symptoms is related to BMI. Therefore, sleep study should be considered in especially overweight or obese COPD patients, even in those without sleep apnea symptoms.

Sleep quality and quality of life in patients with moderate to very severe chronic obstructive pulmonary disease

“…On the other hand, more than half (52.9%) of the patients reported daytime sleepiness as a symptom and this rate was significantly higher in patients with OSA. It is known that ESS appropriateness is controversial in COPD despite it was commonly used for sleep apnea in the literature . Consistent with this statement, no correlation was found between ESS and polygraphic parameters in this study.…”

“…Probable etiologies of sleep disorder in patients with COPD are investigated and their relationship with objective sleep parameters is examined. A common outcome of most of the studies is that sleep disturbance was found in patients with COPD but it was not correlated with objective nocturnal parameters . Similar to these studies, there were no correlations between polygraphic measures and sleep quality, daytime sleepiness and QoL in this study.…”

“…Some studies investigated disturbed sleep in patients with COPD and found that age, gender, smoking history, COPD GOLD stage, dyspnea, comorbidities and FEV 1 (% pred) correlate with AHI or arousal index . Gunduz et al also reported that OSA prevalence is high in COPD patients without OSA symptoms and it is related with BMI. Omachi et al reported that sleep disturbance is associated with dyspnea and COPD severity, but not with FEV 1 .…”

The overlaps of asthma or COPD with OSA: A focused review

“…First, these overlaps are frequently unrecognized. Patients with asthma/COPD may not report sleep symptoms, 72 or may attribute them to the primary lung disease. Standard screening questionnaires are also imperfect.…”

Chronic Obstructive Pulmonary Disease Combined With Obstructive Sleep Apnea: Effects of Non-Invasive Ventilation

“…Сидром обструктивного апноэ сна широко распространен среди больных хронической обструктивной болезнью легких (ХОБЛ), достигая, по оценкам ряда авторов, от 10 % до 66 % и ассоциируясь с увеличением индекса массы тела, степени тяжести бронхиальной обструкции [1,2,3,4].Современные исследования показывают, что синдром обструктивного апноэ сна у больных ХОБЛ ассоциируется не только с нарушениями сна и бодрствования, но и с повышенными риска-ми обострений ХОБЛ, госпитализаций, смерти от всех причин [1,3,5,6,7,8]. Среди возможных механизмов неблагоприятных исходов при сочетании этих заболеваний обращается внимание на персистирующее системное воспаление [2,4,8,9]. Персистирующее системное воспаление у больных ХОБЛ ассоциируется не только с повышенными рисками обострений, но и с неблагоприятными исходами ряда экстрапульмональных заболеваний и смерти от всех причин, находящимися в слабой взаимосвязи со степенью функциональ-ных и структурных изменений легких.…”