The relationship of obstructive sleep apnea risk with the disease severity and clinical parameters in COPD population

Year 2022, Volume: 5 Issue: 1, 67 - 72, 17.01.2022

Ali Onur Keleş Sezgi Şahin Duyar , Funda Aksu , Selma Fırat

https://doi.org/10.32322/jhsm.992192

Abstract

Aim: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) have common pathophysiological mechanisms affecting the prognosis of each other. This study aims to investigate the relationship between the presence of OSA risk and the severity of COPD and to determine the possible clinical features for OSA risk for COPD patients.
Material and Method: The patients (n=181) who applied to the outpatient clinics of pulmonology between September - November 2019 with the diagnosis of COPD, were analyzed cross-sectionally. Demographic features, anthropometric measurements, comorbidities, smoking status, and severity of dyspnea, respiratory functions, and exacerbation frequency in the last year were evaluated. All patients were questioned with the Epworth sleepiness scale (ESS) for detecting excessive daytime sleepiness (EDS), and the STOP-Bang for determining the risk of OSA.
Results: The rate of diabetes, waist and hip circumference measurements, median ESS score, and EDS ratio were found to be higher in patients with moderate/high OSA risk when compared to patients with low OSA risk. In the multivariate regression model; lower oxygen saturation (OR: 0.83; p=0.007) and higher ESS score (OR=1.28; p<0.001) were determined as independent risk factors affecting the OSA risk to be moderate/high.
Conclusion: Low oxygen saturation, accompanying diabetes, high ESS score and, high waist-hip circumference stand out as useful factors in determining OSA risk in the COPD population. However, OSA risk was found to be the same among all COPD stages. We suggest that all COPD patients should be questioned for OSA risk regardless of the stage.

Keywords

Obstructive sleep apnea syndrome (OSAS), Chronic Obstructive Pulmonary Disease (COPD), Epworth sleepiness scale (ESS), STOP-Bang survey

References

• McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Am J Respir Crit Care Med 2009; 180: 692-700.
• Sanders MH, Newman AB, Haggerty CL, et al. Sleep Heart Health Study. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003; 167: 7–14.
• McNicholas WT. COPD-OSA Overlap syndrome: evolving evidence regarding epidemiology, clinical consequences, and management. Chest 2017; 152: 1318‐26.
• Collop N. Sleep and sleep disorders in chronic obstructive pulmonary disease. Respiration 2010; 80: 78-86.
• Kim V, Han MK, Vance GB, et al. The chronic bronchitic phenotype of COPD: an analysis of the COPD gene study. Chest 2011; 140: 626‐33.
• Krachman SL, Tiwari R, Vega ME, et al. Effect of emphysema severity on the apnea-hypopnea index in smokers with obstructive sleep apnea. Ann Am Thorac Soc 2016; 13: 1129.
• Squier SB, Patil SP, Schneider H, Kirkness JP, Smith PL, Schwartz AR. Effect of end-expiratory lung volume on upper airway collapsibility in sleeping men and women. J Appl Physiol (1985) 2010; 109: 977–85.
• Mermigkis C, Kopanakis A, Foldvary‐Schaefer N, et al. Health‐related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome). Int J Clin Pract 2007; 61: 207-11.
• He B-T, Lu G, Xiao S-C, et al. Coexistence of OSA may compensate for sleep-related reduction in neural respiratory drive in patients with COPD. Thorax 2017; 72: 256-62.
• Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J 2019; 53: 1900164.
• Fletcher CM. Standardized questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score). BMJ 1960; 2: 1662.
• Graham BL, Steenbruggen I, Miller MR, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019; 200: e70‐e88.
• Izci B, Ardic S, Firat H, et al. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008; 12: 161-8.
• Acar HV, Kaya A, Yücel F, et al. Validation of the STOP-Bang questionnaire: An obstructive sleep apnoea screening tool in Turkish population. Turk J Anaesthesiol Reanim 2013; 41: 115-20.
• Soler X, Liao SY, Marin JM, et al. 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. PLoS One 2017; 12: e0177289.
• Soler X, Gaio E, Powell FL, et al. High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2015; 12: 1219-25.
• Steveling EH, Clarenbach CF, Miedinger D, et al. Predictors of the overlap syndrome and its association with comorbidities in patients with chronic obstructive pulmonary disease. Respiration 2014; 88: 451-7.
• Sharma B, Feinsilver S, Owens RL, Malhotra A, McSharry D, Karbowitz S. Obstructive airway disease and obstructive sleep apnea: effect of pulmonary function. Lung 2011; 189: 37–41.
• Bednarek M, Plywaczewski R, Jonczak L, Zielinski J. There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study. Respiration 2005; 72: 142–9.
• Price D, Small M, Milligan G, Higgins V, Gil EG, Estruch J. Impact of night-time symptoms in COPD: a real-world study in five European countries. Int J Chron Obstruct Pulmon Dis 2013; 8: 595–603.
• Schreiber A, Cemmi F, Ambrosino N, Ceriana P, Lastoria C, Carlucci A. Prevalence and predictors of obstructive sleep apnea in patients with chronic obstructive pulmonary disease undergoing inpatient pulmonary rehabilitation. COPD 2018; 15: 3, 265-70.
• Carmelli D, Swan GE, Bliwise DL. Relationship of 30-year changes in obesity to sleep-disordered breathing in the Western Collaborative Group Study. Obes Res 2000; 8: 632-7.
• Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46: 85-90.
• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.
• Turcani P, Skrickova J, Pavlik T, Janousova E, Orban M. The prevalence of obstructive sleep apnea in patients hospitalized for COPD exacerbation. Biomed Pap 2015; 159: 422-8.
• Little SA, Elkholy MM, Chalmers GW, Farouk A, Patel KR, Thomson NC. Predictors of nocturnal oxygen desaturation in patients with COPD. Respir Med 1999; 93: 202–7.