Abstract
Background Coexisting obstructive sleep apnoea (OSA) in patients with chronic obstructive pulmonary disease (COPD), defined as overlap syndrome (OVS), is prevalent and underdiagnosed. Routine assessment of OSA is not common practice in COPD care. Our study assessed the clinical impact of sleep-assessment by peripheral arterial tonometry (PAT) in COPD patients.
Methods 105 COPD patients (mean age 68.1±9 years, BMI 28.3±6.0 kg·m−2, 44% males, GOLD stages I to IV in 2%, 40%, 42%, and 16%, respectively) underwent assessment at an outpatient COPD-clinic including anthropometrics, arterial blood gas (ABG) and spirometry in this clinical cohort study, PAT-based sleep studies were performed. Predictors of OVS and ABG were determined. Rapid Eye Movement (REM) sleep-related OSA was analyzed in OVS.
Results 49 COPD patients (46%) suffered from moderate to severe OSA (OVS group, mean AHI 30.8±18 n·h−1, REM-Oxygen Desaturation Index (REM-ODI) 26.9±17 n·h−1). OVS was more prevalent in males compared to females (59% and 37%, p=0.029, respectively). Age (70.1±8 versus 66.3±10 years), BMI (30.0±6 versus 26.4±7 kg·m−2) and hypertension prevalence (71% versus 45%) were elevated (all p<0.03, respectively), while deep sleep (12.7±7% and 15.4±6%, p=0.029) and mean overnight oxygenation (90.6±3% and 92.3±2%, p=0.003) were lower in OVS compared to COPD alone. REM-ODI was independently associated with daytime pCO2 (β=0.022, p<0.001). REM-OSA was associated with an elevated prevalence of atrial fibrillation (25% and 3%, p=0.022).
Conclusions OVS was highly prevalent, specifically in obese males. REM-related OSA showed strong association with elevated daytime pCO2 and prevalent cardiovascular disease. PAT was feasible for sleep assessment in COPD.
Footnotes
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Conflict of interest: Daniel Hansson, report no conflict of interest.
Conflict of interest: Anders Andersson reports personal fees outside the submitted manuscript for lectures in pulmonary medicine from Asta-Zeneca, and Boehringer-Ingelheim.
Conflict of interest: Lowie E.G.W. Vanfleteren reports no conflict of interest related to the study. Outside the scope of the study, he reports payment for lectures, advisory boards or consultancy for Resmed, AstraZeneca, GSK, Novartis, Boehringer and Pulmonx.
Conflict of interest: Kristina Andelid, report no conflict of interest.
Conflict of interest: Ding Zou, report no conflict of interest.
Conflict of interest: Jan Hedner reports support in terms of equipment from Itamar Medical related to the study. Outside the scope of the current study, he reports lecturing activities for Astra Zeneca and Itamar as well as grant support for scientific projects from Desitin and Bayer pharma. He has a co-ownership of a licensed patent for pharmacological sleep apnoea treatment.
Conflict of interest: Ludger Grote reports support from Itamar Medical related to the study (PAT devices and -probes). Outside the scope of the study, he reports lecturing activities for Resmed, Philips, Astra Zeneca, Itamar, and Lundbeck as well as grant support for scientific projects from Desitin and Bayer. He has a co-ownership in a licensed patent for sleep apnoea treatment.
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- Received September 6, 2022.
- Accepted December 11, 2022.
- Copyright ©The authors 2023
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