Effect of lung function on the apnea-hypopnea index in patients with overlap syndrome: a multicenter cross-sectional study

Zhu, Jing; Zhao, Zhiling; Nie, Qingrong; Wang, Yingnan; Fu, Zhen; Guo, Xiaojuan; Hu, Ke

doi:10.1007/s11325-019-01961-w

Cited by 13 publications

(25 citation statements)

References 28 publications

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“…Conversely, data from clinical trials suggest that hyperinflation caused by expiratory airflow limitation may be protective against the development of OSA. Inverse relationships have been reported between AHI and forced expiratory volume in 1 second or radiological emphysema in patients with COPD-OSA overlap (68,77). These findings are consistent with observations that increased end-expiratory lung volume is associated with reduced upper airway collapsibility during NREM sleep (78,79).…”

Section: Copd-obstructive Sleep Apnoea (Osa) Overlapsupporting

confidence: 86%

Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes

D’Cruz¹,

Murphy²,

Kaltsakas³

2020

J Thorac Dis

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Chronic obstructive pulmonary disease (COPD) causes load-capacity-drive imbalance in both wakefulness and sleep, principally driven by expiratory flow limitation and hyperinflation. Sleep imposes additional burdens to the respiratory muscle pump, driven by changes in respiratory muscle tone, neural respiratory drive and consequences of the supine position. COPD patients are therefore at higher risk of decompensation during sleep, which may manifest as altered sleep architecture, isolated nocturnal desaturation, sleep hypoventilation and restless legs. Each form of sleep disordered breathing in COPD is associated with adverse clinical and patient-reported outcomes, including increased risk of exacerbations, hospitalisation, cardiovascular events, reduced survival and poorer quality of life. COPD-obstructive sleep apnoea (OSA) overlap syndrome represents a distinct clinical diagnosis, in which clinical outcomes are significantly worse than in either disease alone, including increased mortality, risk of cardiovascular events, hospitalisation and exacerbation frequency. Sleep disordered breathing is under-recognised by COPD patients and their clinicians, however early diagnosis and management is crucial to reduce the risk of adverse clinical outcomes. In this narrative review, we describe the pathophysiology of COPD and physiological changes that occur during sleep, manifestations and diagnosis of sleep disordered breathing in COPD and associated clinical outcomes.

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Section: Copd-obstructive Sleep Apnoea (Osa) Overlapsupporting

confidence: 86%

Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes

D’Cruz¹,

Murphy²,

Kaltsakas³

2020

J Thorac Dis

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“…We previously showed that OVS patients have higher RBC counts than COPD patients; 15 however, whether OSA increases the prevalence of polycythemia in COPD patients remains unillustrated. It is also important to firmly establish whether polycythemia is associated with other complications in COPD patients to understand the possible adverse effects of polycythemia on prognosis.…”

Section: Introductionmentioning

confidence: 94%

Obstructive Sleep Apnea is Associated with an Increased Prevalence of Polycythemia in Patients with Chronic Obstructive Pulmonary Disease

Zeng¹,

Yan²,

He³

et al. 2022

COPD

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Purpose Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with polycythemia. However, there still remain unanswered questions about the relationship between overlap syndrome (OVS), where OSA and COPD coexist, and polycythemia. Here, we aimed to establish the prevalence of polycythemia in OVS patients and to explore the impact of OSA on polycythemia. Patients and Methods Patients with COPD underwent overnight polysomnography (PSG), pulmonary function tests, echocardiography, and complete blood counts. All patients were ethnic Han Chinese and free of prolonged oral corticosteroid use, hematological system disease, severe systemic disease, and other sleep-disordered breathing. OVS was defined as COPD patients with an apnea–hypopnea index ≥15 events/h, and polycythemia was defined as an Hb >165 g/L in men and >160 g/L in women. Results Eight-hundred and eighty-six patients with COPD were included in the analysis. The prevalence of polycythemia was significantly higher in OVS patients than COPD-alone patients (6.4% vs 2.9%, p < 0.05). The prevalence of polycythemia increased with OSA severity ( χ 2 = 7.885, p = 0.007), but not in GOLD grade 3–4 COPD patients ( χ 2 = 0.190, p = 0.663). After adjusting for confounders, percentage of total sleep time with SaO 2 <90% (TS 90 ) remained independently associated with an increased odds of polycythemia (OR 1.030, 95% CI 1.015–1.046) and, with an increase in TS 90 , the hemoglobin increased, especially in GOLD grade 1–2 patients ( p < 0.05). Conclusion Patients with OVS have a higher prevalence of polycythemia than those with COPD alone, and TS 90 is an independent factor for polycythemia, especially in GOLD1-2 COPD patients.

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“…Also, non-obese COPD patients without OSA had higher FEV1/FVC and FEV1 compared to obese patients [19]. Similarly, Zhu et al in their study reported that the FVC and FEV 1 in obese patients with OS were significantly diminished than in non-obese COPD patients (P < 0.01) [24]. On the other hand, Sleep quality and quality of life were impaired in patients with moderate to very severe COPD.…”

Section: Discussionmentioning

confidence: 92%

“…Gunduz et al found that the frequency of OS in mild hypoxemic COPD patients without symptoms of sleep apnea reached 58% [21]. On the other hand, Zhu et al reported that 67.9% of COPD patients enrolled in their study had OS with wide range of OSA prevalence in different degrees of COPD extending from 2.9 to 65.9% [24]. Similarly, Narasimhan and his colleagues found that the prevalence of OSA in COPD was 53% [34].…”

Section: Discussionmentioning

confidence: 94%

Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

et al. 2021

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Background The conjunction of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome (OS). The coexistence of these diseases has cardiovascular morbidity and mortality. The aim of this study is to assess the prevalence of OSA in COPD patients. One hundred COPD patients (obese and non-obese) performed sleep questionnaires and polysomnograms. Results OSA prevalence in COPD was 50% and it increases with increasing disease severity (P < 0.001). The highest prevalence of OSA was found in obese patients with severe COPD; 90.5% of these patients have OSA. In the OSA group, obese patients were found to have significantly higher STOP-Bang Questionnaire (SBQ), Epworth Sleep Scale (ESS), modified medical research council (mMRC) dyspnea scale, apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI). Both obese and non-obese COPD patients showed significant positive correlations between AHI and smoking index (SI), SBQ, ESS, mMRC, ODI, and neck circumference (NC). Conclusions From this study, it can be concluded that moderate and severe COPD patients had a higher diagnosis of sleep-disordered breathing. Also, obese-COPD patients are more susceptible to develop OSA. Trial registration Name of the registry: Benha University Protocol Record Benha U123, Obstructive Sleep Apnea Prevalence in Patients With Chronic Obstructive Pulmonary Diseases. Trial registration number: NCT04903639. Date of registry: 5/22/2021 (retrospective study).

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Effect of lung function on the apnea-hypopnea index in patients with overlap syndrome: a multicenter cross-sectional study

Cited by 13 publications

References 28 publications

Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes

Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes

Obstructive Sleep Apnea is Associated with an Increased Prevalence of Polycythemia in Patients with Chronic Obstructive Pulmonary Disease

Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

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