Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): The challenge to predict OSA in advanced COPD

Abstract

The combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is associated with substantial morbidity and mortality. We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population. Therefore, we investigated associations between traditional OSA risk factors (e.g. age), and sleep questionnaires [e.g. Epworth Sleepiness Scale] in 44 patients with advanced COPD. As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD. In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events (e.g. atrial fibrillation), and sleep questionnaires [e.g. Pittsburgh Sleep Quality Index (PSQI)]. For the pilot questionnaire, a BMI ≥25 kg/m2 and the presence of cardiovascular disease were used to construct the pilot screening test. Male: 59%; OSA 66%. FEV1 (mean ± SD) = 41.0±18.2% pred., FEV1/FVC = 41.5±12.7%]. Male gender, older age, and large neck circumference were not associated with OSA. Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression. In contrast, BMI ≥25 kg/m2 (OR = 3.94, p = 0.04) and diagnosis of cardiovascular disease (OR = 5.06, p = 0.03) were significantly associated with OSA [area under curve (AUC) = 0.74]. The pilot COPD-OSA test (OR = 5.28, p = 0.05) and STOP-Bang questionnaire (OR = 5.13, p = 0.03) were both associated with OSA in Receiver Operating Characteristics (ROC) analysis. The COPD-OSA test had the best AUC (0.74), sensitivity (92%), and specificity (83%). A ten-fold cross-validation validated our results.We found that traditional OSA predictors (e.g. gender, Epworth score) did not perform well in patients with more advanced COPD. Our pilot test may be an easy to implement instrument to screen for OSA. However, a larger validation study is necessary before further clinical implementation is warranted.

The prevalence and risk factors associated with snoring and obstructive sleep apnea in jazan region

“…Only male gender had no significant association with reported OSA. In a study conducted among patients who underwent pulmonary rehabilitation program no association between male gender and OSA was found [21]. In the current study, smoking had no significant associations with reported OSA, which was consistent with Alharthi et al [15].…”

“…In the current study, smoking had no significant associations with reported OSA, which was consistent with Alharthi et al [15]. In a study conducted among patients who underwent pulmonary rehabilitation program no significantl association between predictors such as male sex, old age group, and large neck circumference not and OSA was found [21]. Several studies conducted in Saudi Arabia among patients with chronic diseases such as coronary heart diseases [22] or chronic renal failure [23] and their findings differed markedly from findings of the present study that surveyed general population.…”

“…Binary logistic results showed that the presence of hypertension and respiratory arrest observed by others during sleep were significant predictors for reported OSA. Soler et al conducted a logistic regression analysis and found traditional predictors of OSA, included in STOB-BANG questionnaire, not significant except for the presence of cardiovascular diseases [21]. The logistic regression is usually controlling the confounding effects of the variables introduced in the model, thus many significant associations which previously detected by Chi-Square became non-significant associations in the regression model.…”

Sleep in chronic respiratory disease: COPD and hypoventilation disorders

“…Questionnaires to screen and determine the probability of OSA, such as the Epworth Sleepiness Scale, the STOP BANG or the Berlin questionnaire, have not been specifically validated for patients with coexisting COPD and should therefore be used with some caution [41]. Specific sleep-related questionnaires for COPD patients have been developed but clinical experience is limited [42,43].…”

“…This is unfortunate as the prevalence of SDB in COPD is likely to be high, if only because of the high general population prevalence of SDB, and treatment opportunities are abundant. Some reports indicate a higher prevalence of SDB in COPD compared to the general population [29,42], whereas other reports indicate no increase [24,45]. These contrasting findings may reflect differences in promoting and protective factors for SDB between study populations [21].…”