There Is No Relationship between Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome: A Population Study

Abstract

Background: Both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) are common diseases. Some recent studies suggest an increased prevalence of COPD among subjects with OSAS. Objectives: The study objective was to evaluate whether there is an epidemiological relationship between COPD and OSAS in a random population sample. Materials and Methods: The study population, 356 males (53%) and 320 females, mean age 56.6 ± 8.2 years (range 41–72), was selected from a voting list for parliamentary election in Warsaw. The investigation included lung diseases and smoking history with polysomnography and spirometry. Results: OSAS was diagnosed in 76 subjects (11.3%), 59 males (8.8%) and 17 females (2.5%), mean apnea/hypopnea index (AHI) was 25.3 ± 16.1, mean overnight SaO₂ 92.1 ± 3.3%, minimum SaO₂ 76.9 ± 9.4%, and SaO₂ <90% = 18.9 ± 23.9% of total sleep time. COPD was diagnosed in 72 subjects (10.7%), 39 males and 33 females. Severity of airflow limitation was assessed according to European Respiratory Society (ERS) guidelines: mild in 70%, moderate in 22%, and severe in 8%. In 7 subjects (9.2% of OSAS population, 1% of total population) OSAS and COPD overlapped. Polysomnographic variables were compared between overlap (overlap syndrome, OS) and OSAS subjects. In the OS mean AHI was 19.0 versus 25.3 in OSAS (nonsignificant), mean SaO₂ 89.6 versus 92.3% in OSAS (p < 0.005), and time spent in SaO₂ <90% was 25.4 versus 18.2% in OSAS (p = 0.04). Conclusions: COPD in subjects with OSAS was as frequent as in the general population. In the OS group mean arterial blood saturation was lower and time spent in desaturation was longer than in OSAS. The presented data suggest a more severe course of sleep-disordered breathing in subjects with coexisting COPD.

Overnight Changes in Lung Function of Obese Patients with Obstructive Sleep Apnoea

“…Indeed, reduced lung volumes, decreased elasticity and increased resistance of the lower airways are associated with more severe disease [2][3][4][5]. In addition, chronic airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), influence the course of OSA [6,7]. Lower airway inflammation and oxidative stress are accelerated in OSA with a direct relationship between disease severity and the magnitude of lower airways inflammation [8].…”

The prevalence of obstructive sleep apnea in patients hospitalized for COPD exacerbation

“…16 ), other studies seem to deny the link between COPD and (mild) OSA (ref. 17,18 ). This is probably caused by the fact that the definitions of each of these diseases have been evolving over time, the diagnostic algorithms have not always been consistent, both COPD and OSA have several stages of severity, and different prevalence studies have been using different methodologies 19 .…”

Supplemental Oxygen Needs During Sleep. Who Benefits?

“…[61][62][63] More recent data from the Sleep Heart Health Study and the European MONICA II study did not find an association between the 2 diseases. 64,65 The major limitation of these studies is that most subjects had very mild airway obstruction on spirometry. Whether any pathophysiological link exists between OSA and severe COPD is still unknown.…”