Increased risk for cardiovascular disease in patients with obstructive sleep apnoea syndrome‐chronic obstructive pulmonary disease (overlap syndrome)

Abstract

Introduction: Accumulating evidence suggests that cardiovascular disease (CVD) is highly prevalent among patients with concurrent obstructive sleep apnoea syndrome (OSAS) and chronic obstructive pulmonary disease, otherwise known as overlap syndrome (OS). Objectives: The aim of this study was to investigate the 10-year risk for CVD in OS patients compared with OSAS patients and controls. Methods: Consecutive patients, referred for symptoms suggestive of OSAS, were evaluated with polysomnography and pulmonary function testing. Cardiovascular risk was assessed using the Framingham risk score (FRS) and systematic coronary risk evaluation (SCORE). Results: Overall, 244 participants (184 males) without CVD and diabetes were divided into 3 groups: controls (n = 63), OSAS (n = 139) and OS (n = 42). Both FRS and SCORE were found to be elevated in the OS group compared with the OSAS and control groups (P < .001 for all). In multivariate analysis, age (β = .461, P < .001), forced expiratory volume in first second (β = −.285, P = .036) and oxygen desaturation index (ODI) (β = .234, P = .007) were major determinants for the SCORE, whereas age (β = .308, P < .001) and apnoea-hypopnoea index (β = .252, P = .010) for the FRS. Conclusion: In our study, an increased risk for CVD was observed in a group of patients with OS at the time of their initial evaluation. Further studies are needed in the field of OS in order to investigate, prevent and manage early CVD in this population.

The Association Between Serum/Plasma Leptin Levels and Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression

“…However, further well-designed large-scale studies involving various ethnicities and geographical contexts are encouraged. The present conclusions have clinical importance because an elevated leptin level could be a risk factor for the development of cardiovascular disease in adults with OSAS ( 47 ). It is crucial to understand the mechanism which drive these changes in leptin levels because leptin has been reported to be related with an increased risk of myocardial infarction, hemorrhagic stroke, abnormal fibrinolysis in men and postmenopausal women ( 48 – 50 ) .…”

Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome

“…In addition, recent studies have shown that patients with OS are also frequently affected from cardiometabolic disorders [13,14]. Specifically, OS is often related with either an increased risk of cardiovascular disease (CVD) [15], or with established CVD [16], and mainly pulmonary hypertension (PH) [17], which is the best studied comorbidity in this specific population. Decreased oxyhemoglobin saturation during sleep and wakefulness, impaired lung function, increased oxidative stress, as well as tobacco exposure, reduced physical activity and increased body mass index (BMI) are amongst the recognized factors which contribute to the development of CVD in patients with OS [10].…”

Risk for Cardiovascular Disease and One-Year Mortality in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome Overlap Syndrome

“…COPD and OSAS have been reported to be correlated with hypertension, stroke, arrhythmia, heart failure and ischemic heart disease. Voulgaris et al reported an increased risk for cardiovascular disease in OS patients by using the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE) scoring models ( Voulgaris et al, 2019 ), but specific changes in the incidence of each cardiovascular disease were not discussed. In this study, significantly higher incidence of heart failure and PH was observed in the OS group, and CHD was also more common in the OS group than in the COPD group.…”