High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe COPD

Abstract

Rationale: When obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) coexist in the so-called "overlap" syndrome, a high risk for mortality and morbidity has been reported. There is controversy about the prevalence of OSA in people affected by COPD.Objectives: The purpose of this study was to investigate objective meaures of sleep-disordered breathing in patients with moderate to severe COPD to test the hypothesis that COPD is associated with an increased prevalence of OSA.Methods: Fifty-four patients (54% men) with moderate to severe COPD were enrolled prospectively (mean 6 SD, FEV 1 = 42.8 6 19.8% predicted, and FEV 1 /FVC = 42.3 6 13.1). Twenty patients (37%) were on supplemental oxygen at baseline. Exercise tolerance; questionnaires related to symptoms, sleep, and quality of life; and home polysomnography were obtained.Measurements and Main Results: Forty-four patients had full polysomnography suitable for analysis. OSA (apnea-hypopnea index . 5/h) was present in 29 subjects (65.9%). Sleep efficiency was poor in 45% of subjects.Conclusions: OSA is highly prevalent in patients with moderate to severe COPD referred to pulmonary rehabilitation. Sleep quality is also poor among this selected group. These patients have greaterthan-expected sleep-disordered breathing, which could be an important contributory factor to morbidity and mortality. Pulmonary rehabilitation programs should consider including a sleep assessment in patients with moderate to severe COPD and interventions when indicated to help reduce the impact of OSA in COPD.

Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity

“…Our participants were not screened for sleep-related disorders, such as obstructive sleep apnoea (OSA). However, because COPD and OSA are both common chronic conditions, these should be expected to occur together, particularly among overweight individuals with COPD 40. Moreover, no significant differences were previously found in measures of dyspnoea, sleep quality, sleep efficiency and sleepiness during the day between patients with COPD only and patients with COPD-OSA overlap 40.…”

Chronic obstructive pulmonary disease comorbidities

“…Sleep apnea has been found, by polysomnography, in 65.9% of patients with moderate to severe COPD [36], and both COPD and sleep apnea were present in 35% of obese study participants with hypoxemia [37]. Less is known about the mechanisms of this comorbid association, with emerging data linking sleep apnea with higher inflammatory markers in COPD study participants with sleep apnea [38].…”

COPD+OSA: can two bad things be good for you?

“…Similarly, patients with OSA may have similar AHIs, but may have very different clinical presentations and disease sequelae. What is more, because the measurement of hypopnoeas is based on oxygen desaturation, the degree of lung disease can influence the number of respiratory events (which might contribute to the apparently high prevalence of OSA in chronic lung diseases) 14 15…”