Obstructive Sleep Apnea Increases the Prevalence of Hypertension in Patients with Chronic Obstructive Disease

Hu, Weihua; Zhao, Zhiling; Wu, Bin; Shi, Zhihong; Dong, Minglin; Xiong, Mengqing; Yan, Jiang; Liú, Dan; Li, Huimin; Hu, Ke

doi:10.1080/15412555.2020.1815688

Cited by 16 publications

(38 citation statements)

References 48 publications

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“…Steveling et al reported a prevalence of OSA in patients with COPD of 35% based on an AHI of >5 events per hour, 26 while Hu et al reported that 68.18% of COPD patients had coexisting OSA (AHI ≥5). 27 In a meta-analysis by Shawon et al, 2.9%-65.9% of patients with COPD had coexisting OSA. 7 The reported prevalence of OSA in patients with COPD thus varies widely, due to different methodologies, diagnostic de nitions, and demographic characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…35 We analyzed the risk of OSA in patients with COPD by multiple logistic regression analysis after adjusting for age, sex, BMI, smoking index, and other confounding factors, and showed that hypertension and diabetes were independent risk factors in patients with COPD with coexisting moderate to severe OSA, consistent with other reports. 27,34,36 A previous study found that patients with overlap syndrome had more comorbidities, including hypertension and diabetes. 30,34,37 Hypertension is the most frequently occurring comorbidity, while diabetes also damages lung function.…”

Section: Discussionmentioning

confidence: 99%

“…The current results showed that BMI and neck circumference were signi cant predictors for OSA, consistent with other reports. [26][27][28][29] This might be because trunk obesity can reduce chest wall compliance and respiratory muscle strength, resulting in ventilation disturbances and ventilation perfusion mismatch. 30 In addition, individuals with larger necks have increased subcutaneous and visceral fat, resulting in crowding of the tonsils, uvula, palatopharyngeal arch, and pharyngeal lateral cord, leaving a narrow gap for air ow and leading to variety of whistling sounds.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with patients with COPD alone, patients with COPD plus OSA had higher FEV 1 , FEV 1 % of predicted value, and FEV 1 /FVC, and a lower proportion of severe COPD. [26][27][28]39 The incidence of OSA increased with increasing air ow restriction in COPD patients with AHI <5 events per hour, and decreased with increasing air ow restriction in COPD patients with AHI >30 events per hour. Compared with patients with mild and moderate air ow restriction, the proportion of AHI <5 events per hour was higher and the proportion of AHI >30 events per hour was lower in patients with severe air ow restriction.…”

Section: Discussionmentioning

confidence: 99%

“…7 The reported prevalence of OSA in patients with COPD thus varies widely, due to different methodologies, diagnostic de nitions, and demographic characteristics. 27 However, another survey of inpatients in tertiary hospitals in China found that 77.7% of COPD patients had OSA, 28 indicating that overlap syndrome was common among COPD patients in China. These results suggest that family doctors should screen COPD patients for OSA, to improve their quality of life…”

Section: Discussionmentioning

confidence: 99%

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Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in China: a cross-sectional study

Zhang¹,

Bi²,

Lou³

et al. 2021

Preprint

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‘Overlap syndrome’ refers to obstructive sleep apnea (OSA) combined with chronic obstructive pulmonary disease (COPD), and has poorer outcomes than either condition alone. We aimed to evaluate the prevalence and possible predictors of overlap syndrome and its association with clinical outcomes in patients with COPD. We conducted a cross-sectional study in 842 patients with COPD. We assessed the modified Medical Research Council dyspnea scale (mMRC), Epworth sleepiness scale (ESS), COPD assessment test (CAT), Hospital Anxiety and Depression Scale (HADS), Charlson Comorbidity Index (CCI), and STOP-Bang questionnaire (SBQ) and performed spirometry and full overnight polysomnography in all patients. An apnea–hypopnea index (AHI) ≥ 5 events per hour was considered to indicate OSA. Participants were divided into a COPDOSA group with AHI ≥ 15 events per hour and a COPD group with AHI < 15 events per hour. Risk factors for OSA in COPD patients were identified by univariate and multivariate logistic regression analyses. A total of 556 patients (66%) had an AHI ≥ 5 events per hour. There were no significant differences in age, sex ratio, mMRC score, smoking index, number of acute exacerbations and hospitalizations in the last year, and prevalence of cor pulmonale between the two groups (all p > 0.05). Body mass index (BMI), neck circumference, CAT score, CCI, ESS, HADS, and SBQ scores, forced expiratory volume (FEV)1, FEV1%, FEV1/forced vital capacity ratio, and prevalence of hypertension, coronary heart disease, and diabetes were all significantly higher and the prevalence of severe COPD was significantly lower in the COPDOSA group compared with the COPD group (p < 0.05). BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in COPD patients (p < 0.05). SBQ could be used for OSA screening in patients with COPD. Patients with severe COPD (FEV1% <50%) had a lower risk of OSA compared with patients with mild or moderate COPD (β=−0.459, odds ratio = 0.632, 95% confidence interval 0.401–0.997, p = 0.048). Conclusions Patients with overlap syndrome had a poorer quality of life, more daytime sleepiness, and a higher prevalence of hypertension and diabetes than patients with COPD alone. BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in patients with COPD. The risk of OSA was lower in patients with severe, compared with mild or moderate COPD.

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Section: Discussionmentioning

confidence: 99%