<p>The Bronchiectasis in COPD-OSA Overlap Syndrome Patients</p>

Abstract

Purpose: COPD-OSA (chronic obstructive pulmonary disease-obstructive sleep apnea) overlap syndrome is associated with more frequent COPD acute exacerbations than COPD without OSA. With the application of high-resolution computed tomography (HRCT) in COPD, bronchiectasis is commonly detected and is associated with disease severity. Sleep respiratory disease is also associated with bronchiectasis; however, the correlation between OSA and coexisted bronchiectasis in COPD (COPD-Bx) has not been reported yet. Patients and Methods: A total of 124 consecutive patients with stable COPD were enrolled. All subjects completed the chest HRCT and nocturnal polysomnography (PSG). The scores of extent and severity in bronchiectasis were assessed based on the Smith method and the Bhalla scoring system. Clinical data, questionnaire, routine blood test data, blood levels of C-reactive protein (CRP) and Immunoglobulin E, and the lymphocyte subtype were collected. Results: Among all enrolled patients, 56.45% (70/124) were diagnosed as COPD-OSA based on the results of PSG screening. Bronchiectasis was detected in 42.86% (30/70) of the patients with COPD-OSA, but in 18.52% (10/54) of the patients without OSA (χ2=8.264, p=0.004). PSG screening revealed that COPD with OSA had a significantly higher apneahypopnea index and percent of time spent with oxygen saturation below 90% (T90). Higher values of CRP, T90, and lower CD4/CD8 in the COPD-Bx with OSA were detected compared to COPD-Bx without OSA. Correlation analysis showed that the Bhalla severity score was related to CD8 cell count (r=0.446, p<0.05) and CD4/CD8 (r=−0.357, p<0.05) in all the COPD-Bx patients. The Smith extent score was also associated with the values of CD8 count (r=0.388, p<0.05) and CD4/CD8 (r=−0.381, p<0.05). Conclusion: The comorbid bronchiectasis was more common in COPD-OSA overlap syndrome patient and may be related to more severe hypoxia and increased systemic inflammation.

The Impact of Lung Function Parameters on Sleep Among Aboriginal Australians – A Polysomnography and Spirometry Relationship Study

“…46,47 In addition to COPD, literature also shows evidence for significant nocturnal symptoms among patients with bronchiectasis, [48][49][50] with the prevalence of OSA particularly increased among patients with comorbid COPD & bronchiectasis. 51 Although bronchiectasis was not reported in the current study, among Aboriginal Australian children in the NT, the incidence of bronchiectasis has been reported to be the highest seen worldwide, 52 and among Aboriginal Australian adults with COPD in the NT, comorbid bronchiectasis is seen in about 30%. 6,10,34,53,54 In this population, bronchiectasis has been associated with restrictive impairment on spirometry, 54 and a restrictive impairment was common in the current study.…”

Obstructive sleep apnea and nocturnal hypoxemia in adult patients with cystic fibrosis

“…There is growing evidence that patients with OSA-COPD overlap experience more pulmonary exacerbations and have a higher mortality than patients with COPD alone [ 37 , 38 ]. In addition, patients with OSA-COPD and concomitant bronchiectasis had higher AHI and lower nocturnal oxygen levels than patients with OSA or COPD alone [ 39 ]. Comparable data do not exist for pwCF.…”

<p>Role of the Bronchodilator Test Defined by the Forced Vital Capacity in Chronic Obstructive Pulmonary Disease Phenotyping</p>

“…Another possible explanation is the decreased pulmonary diffusing capacity of NO due to irreversible structural defects caused by emphysema. 20,21 Airway inflammation is a consistent feature of COPD. Despite the fact that neutrophilic infiltration is the most common inflammatory phenotype in COPD, eosinophilic infiltration does exist in a subset of COPD patients, even after the careful exclusion of patients with any features of asthma.…”