Overlap syndrome: Additive effects of COPD on the cardiovascular damages in patients with OSA

Abstract

The chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have been recently much focused as independent risks for cardiovascular disease. Furthermore, the complication of both has a worse prognosis compared with patients with only one of these diseases. However, the details of the underlying mechanisms of this worsened prognosis have not been clear. The cross-sectional study was conducted to examine whether the overlap of COPD augment the increase in arterial stiffness in subjects with OSA. If so, we examined the exaggeration of nocturnal hypoxemia and its related inflammation are related to this augmentation of increased arterial stiffness. In 524 male subjects with OSA diagnosed by polysomnography (apnea-hypopnea index >5/h) (52 ± 14 years old), the forced expiratory volume at 1 s/the forced vital capacity (FEV(1)/FVC) ratio, brachial-ankle pulse wave velocity (baPWV), blood C-reactive protein (CRP) and B-natriuretic peptide (BNP) levels were measured. The prevalence rate of COPD was 12% in this study subjects. Plasma BNP levels and the crude (median value, 17.2 vs. 14.1 m/s, p < 0.01) and adjusted value of baPWV were significantly higher in subjects with overlap syndrome than in those with OSA alone. However, parameters of nocturnal hypoxemia and serum CRP levels were similar between both groups. Thus, the overlap of COPD in patients with OSA augments increase in arterial stiffness without the exaggeration of nocturnal hypoxemia and inflammation. Even so, this augmentation may partially contribute to the increased cardiovascular risk in the overlap syndrome.

Pulmonary Rehabilitation Improves Subjective Sleep Quality in COPD

“…First, the overlap of obstructive sleep apnea syndrome in patients with COPD may exacerbate poor sleep quality. 49 In previous studies, the prevalence of overlap syndrome in COPD was 8.6 -11%. 50,51 Polysomnography was not performed in the current study, and the prevalence of organic sleep disorders in this study population could not be objectively determined.…”

Predictors of the Overlap Syndrome and Its Association with Comorbidities in Patients with Chronic Obstructive Pulmonary Disease

“…In patients with overlap syndrome, the mortality due to cardiovascular events has been shown to be higher in comparison to one single disease alone [25] . Some preliminary evidence that both diseases may lead to systemic inflammation [26] , and accelerate atherosclerosis [27,28] and vascular dysfunction [29,30] , and thus might increase comorbidities such as arterial hypertension [31] , have been presented before. This is in line with our findings that those with the overlap syndrome had a higher rate of arterial hypertension and diabetes.…”

Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors

“…Other cardiovascular risk factors, such as renal dysfunction, as assessed by the serum creatinine or cystatin C levels and pulmonary dysfunction are also reported to be associated with an increase of the brachial-ankle PWV [37][38][39][40] . Increased brachial-ankle PWV values have also been reported in subjects with osteoporosis or sarcopenia [40][41][42] .…”