Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort

Donovan, Lucas M.; Feemster, Laura C.; Udris, Edmunds M.; Griffith, Matthew; Spece, Laura J; Palen, Brian; He, Ken; Parthasarathy, Sairam; Kapur, Vishesh K.; Au, David H.

doi:10.5664/jcsm.7574

Cited by 34 publications

(23 citation statements)

References 34 publications

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“…Little is known about the pathophysiological and clinical consequences of having concomitant COPD and OSA. A complex interaction between hypoxemia, inflammatory mediators and elevated sympathetic activity has been proposed to explain the high risk of death and COPD exacerbation compared to a COPD‐only population . Patients with coexisting COPD and sleep apnoea develop more severe oxygen desaturation during sleep and experience a higher rate of respiratory insufficiency than OSA‐only patients .…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

Jaoude

El-Solh

2019

Clinical Respiratory J

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Introduction:Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA)-overlap syndrome-have a substantially greater risk of morbidity and mortality, compared to those with either COPD or OSA alone. Objectives: The aim of this retrospective study was to identify clinical modifiable factors associated with COPD exacerbations and all-cause mortality in patients with overlap syndrome. Methods:The electronic records of patients with simultaneous COPD and OSA who had a documented acute exacerbation of COPD during a 42-month period were evaluated for reviewed. A control group of overlap syndrome patients without exacerbations was matched 1:1 for age and body mass index. Vital status and cause of death were assessed through the population death registry. Results: Out of 225 eligible cases, 92 patients had at least one episode of COPD exacerbation. There was no significant association between severity of airflow limitation and apnoea hypopnea index (P = .31). After adjusting for confounding variables, patients who had at least one COPD exacerbation were more likely to be active smokers (P = .01), have poorer lung function (P = .001) and less likely to adhere to continuous positive airway pressure (CPAP) use (P = .03). All-cause mortality was also correlated with low forced expiratory volume in 1 second (P = .006), CPAP use (P = .007), and burden of comorbidities (P < .001). Conclusion: Lung function and CPAP use were independent predictors of COPD exacerbations and all-cause mortality in a cohort of patients with overlap syndrome.These factors should be taken into account when considering the management and prognosis of these patients. K E Y W O R D S

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Section: Introductionmentioning

confidence: 99%

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

Jaoude

El-Solh

2019

Clinical Respiratory J

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“…The diagnosis of COPD was made according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. 14 The exclusion criteria included acute exacerbation in the past two months and a history of neurological problems (e.g., Alzheimer's disease, severe cerebrovascular disease and severe head injury), history of significant psychological disorders (e.g., substance abuse, bipolar disorder and schizophrenia), mental retardation, and history of noninvasive positive airway pressure (NIPAP) or nocturnal oxygen therapy at home. This study was conducted in accordance with the Declaration of Helsinki.…”

Section: Patient Populationmentioning

confidence: 99%

“…13 OSA is common in patients with COPD and adversely impacts quality of life. 14 Patients with OSA and COPD (overlap syndrome) may develop more severe nocturnal hypoxia than those with OSA or COPD alone. Olaithe et al studied the separate effects of untreated OSA, COPD and sleep deprivation on cognitive function with a systematic review and meta-analysis and they found that COPD and OSA shared some common cognitive deficits (executive function, memory, attention, language abilities and psychomotor function), which suggests a core role for hypoxia.…”

Section: Introductionmentioning

confidence: 99%

<p>Moderate-to-Severe Obstructive Sleep Apnea and Cognitive Function Impairment in Patients with COPD</p>

Zhang¹,

Gao²,

Han³

et al. 2020

COPD

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Prior studies have indicated that patients with chronic obstructive pulmonary disease (COPD) exhibit significant cognitive defects on neuropsychological testing. Obstructive sleep apnea (OSA) is common in patients with COPD and is associated with reduced cognitive function; however, the combined impact of these two conditions on cognitive function is unknown. The aim of the study was to investigate the impact of OSA on cognitive impairment in patients with COPD. Methods: Sixty-five stable COPD patients aged over 60 years underwent overnight polysomnography (PSG). Global cognitive functions were evaluated using the Mini-Mental State Examination (MMSE). Results: Compared to patients with COPD alone, patients with both COPD and OSA performed worse on the MMSE (25.5±2.9 vs 23.5±3.2; p=0.01) and were more likely to be at risk for developing dementia based on the MMSE score (MMSE≤24) (31% vs 66%; p<0.01), independent of key demographic, educational and medical variables known to affect cognitive function in COPD. COPD patients with an apnea hypopnea index (AHI) of ≥30 events/h had lower MMSE scores than those with an AHI of <15 events/h. In addition to age and education level, the severity of nocturnal intermittent hypoxia is an independent predictor of the risk of dementia in patients with COPD (OR=1.24, 95% CI 1.04-1.48, p = 0.02). Conclusion: The current findings indicate that patients with COPD with comorbid OSA may be at greater risk for global cognitive impairment relative to patients with COPD alone. The mechanisms underlying the exaggerated cognitive dysfunction seem to be related to intermittent hypoxia. Further work is needed to understand the impact of OSA on the specific domains of cognitive impairment and the therapeutic implications of OSA in COPD.

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“…In fact, the presence of the OS was associated with a high frequency of hospitalizations from COPD exacerbations, severe respiratory symptoms, and low quality of life. Thus, increasing all-cause mortality compared with those with just COPD alone [46,47]. Also, the incidence of acute respiratory failure in patients diagnosed with the OS is increased compared with either disease alone and correlated to nocturnal hypoxemia particularly in obese individuals.…”

Section: Clinical and Cardiovascular Consequencesmentioning

confidence: 99%

The deleterious effects of chronic obstructive pulmonary disease and obstructive sleep apnea: pathophysiology and implications on treatment

Gharib

2020

Egypt J Bronchol

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Background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both common in the adult population. The coexistence and association of both COPD and OSA have been described as the overlap syndrome. The scope of the present review is to address the magnitude, pathophysiology, clinical presentations, and the deleterious consequences of the coexistence of COPD and OSA in the same patient as well as the current management and treatment options of this association. Main body of abstract: Epidemiological studies showed a prevalence of the overlap syndrome of up to 1% of the adult population. However, various studies agreed that this association is due to the fact that both COPD and OSA are common rather than an interaction of pathophysiology between the two affections. Nevertheless, sleep may cause adverse effects on breathing and lung functions. While these effects can be neglected in otherwise healthy individuals, they can lead in contrast to disastrous clinical outcomes particularly in vulnerable patients with the overlap syndrome leading to increased risk of cardiovascular diseases, acute COPD exacerbations, increased rates of hospitalizations, and nocturnal deaths. Current guidelines recommend polysomnography (PSG) as the gold standard investigation to diagnose sleep disorders and overlap syndrome. Treatment may include pulmonary rehabilitation, supplemental oxygen therapy, and non-invasive ventilation. Currently, continuous positive airway pressure (CPAP) therapy is the treatment of choice for the overlap syndrome. CPAP effects include improved respiratory mechanics; sleep quality, exercise tolerance, and prolonged survival. Conclusion: Both COPD and OSA are common in the general population and present a significant risk of increased morbidity and mortality when they coexist in the same patient. Clinicians must carefully evaluate the clinical outcomes and the high risk of cardiovascular complications related to the overlap syndrome. Current data indicate that CPAP treatment leads to amelioration of the health-related quality of life and improve survival in patients with the overlap syndrome.

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Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort

Cited by 34 publications

References 34 publications

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

<p>Moderate-to-Severe Obstructive Sleep Apnea and Cognitive Function Impairment in Patients with COPD</p>

The deleterious effects of chronic obstructive pulmonary disease and obstructive sleep apnea: pathophysiology and implications on treatment

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