Analysis of the Long-Term Correlation Between Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A 10-Year Retrospective Study

Öz

Aim: The primary objective of this study is to evaluate the prevalence of overlap syndrome (OS) in patients with Chronic Obst- ructive Pulmonary Disease (COPD) who exhibit symptoms of Obstructive Sleep Apnea (OSA) and are undergoing polysomnog- raphy. The study also aims to explore the influence of hypoventilation and long-term oxygen therapy (LTOT) on the severity of OSA. Materials and Methods: A retrospective analysis was conducted on COPD patients presenting symptoms of OSA who underwent polysomnography between August 2012 and September 2022. Data on the patients’ body mass index (BMI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), minimum and mean oxygen saturation levels (minSpO2 and meanSpO2), sleep efficiency, percentage of REM period (REM%), LTOT usage, hematocrit levels, and awake arterial carbon dioxide (PaCO2) levels were collected. Results: The study involved 81 COPD patients. Among them, 76 individuals (93.9%) had an AHI>5, with 9 classified as having mild OSA, 24 as moderate OSA, and 43 as severe OSA. The average sleep efficiency was 78.3%, and the mean REM% value was 7.3. Sixteen patients (19.7%) were using LTOT, and a statistically significant higher sleep efficiency was observed in this group (p=0.048). Patients with elevated PaCO2 levels exhibited significantly higher AHI and ODI values compared to those with nor- mal PaCO2 levels (p=0.048, p=0.008, respectively). Additionally, the mean minSpO2 and meanSpO2 values were lower in the high PaCO2 group (p=0.013, p=0.008, respectively). Conclusion: In individuals with OS, reduced sleep efficiency is noted, and elevated PaCO2 levels are associated with decreased minSpO2 and meanSpO2 levels, higher ODI and AHI values. The utilization of LTOT is linked to improved sleep efficiency.

Anahtar Kelimeler

• apnea
• hypoventilation
• obesity
• polysomnography

Obstrüktif Uyku Apnesi ile Kronik Obstrüktif Akciğer Hastalığı Arasındaki Uzun Dönem İlişkinin Analizi: 10 Yıllık Retrospektif Bir Çalışma

Öz

Amaç: Bu çalışmanın amacı, Kronik obstrüktif akciğer hastalığı (KOAH) olup obstrüktif uyku apnesi (OUA) belirtileri nede- niyle polisomnografi yapılanlarda, overlap sendromu (OS) prevalansını belirlemektir. Ayrıca, hipoventilasyon ve uzun süreli oksijen tedavisinin (USOT) OUA şiddetine etkisini inceledik. Gereç ve Yöntemler: Ağustos 2012’den Eylül 2022’ye kadar OUA semptomları olup polisomnografi yapılan KOAH hastalarını retrospektif olarak inceledik. Hastaların vücut kitle indeksleri (VKİ), apne-hipopne indeksleri (AHİ), oksijen desatürasyon indeksleri (ODI), minimum ve ortalama oksijen satürasyon değerleri (minSpO2 ve ortalamaSpO2), uyku aktiviteleri, REM pe - riyodu yüzdeleri (%REM), USOT kullanıp kullanmadıkları, kan hematokrit düzeyleri ve uyanık arteriyel karbondioksit parsiyel basıncı (PaCO2) seviyeleri kaydedildi. Bulgular: Çalışmaya toplam 81 KOAH’lı birey dahil edildi. AHI>5 ve OS olan birey sayısı 76 (%93,9) idi. Çalışmaya dahil edilenlerin 9’u hafif, 24’ü orta ve 43’ü şiddetli OSA olarak bulundu. Ortalama uyku etkinliği 78,3 (±16,2) ve %REM değe- ri 7.3 idi. Hastaların 16’sı (%19.7) USOT alıyordu. Uyku etkinliği USOT kullanan grupta istatistiksel olarak daha yüksekti (p=0,048). PaCO2’si yüksek olan grupta AHI ve ODI değerleri olmayan gruba göre istatistiksel olarak yüksek bulundu (sıra- sıyla; p=0,048, p=0,008). Ayrıca minSpO2 ve meanSpO2 değerleri PaCO2’si yüksek olan grupta daha düşük bulundu (sırasıyla p=0,013, p=0,008). Sonuç: KOAH-OSA overlap hastalarda uyku etkinliği düşüktür ve noktürnal hipoventilasyon daha düşük minSpO2 ve me- anSpO2, daha yüksek ODI ve AHI ile ilişkilidir. USOT kullanımı OS’li hastalarda uyku etkinliğini artırmaktadır.

Anahtar Kelimeler

• apne
• hipoventilasyon
• obezite
• polisomnografi

Kaynakça

1. 1. Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: The Sleep AHEAD study. Archives of Internal Medicine. 2009;169(17):1619-1626.
2. 2. Stelmach-Mardas M, Brajer-Luftmann B, Kuśnierczak M, BaturaGabryel H, Piorunek T, Mardas M. Body mass index reduction and selected cardiometabolic risk factors in obstructive sleep apnea: meta-analysis. Journal of Clinical Medicine. 2021;10(7):1485.
3. 3. Alkhalil M, Schulman ES, Getsy J. Obstructive sleep apnea syndrome and asthma: the role of continuous positive airway pressure treatment. Ann Allergy Asthma Immunol. 2008;101(4):350-357.
4. 4. Inönü Köseoğlu H, Kanbay A, Köktürk O. An important concomitancy: interstitial lung diseases and sleep related breathing disorders. Tuberkuloz ve Toraks. 2014;62(3):231-235.
5. 5. Malhotra A, Schwartz AR, Schneider H, Owens RL, DeYoung P, Han MK, et al. Research priorities in pathophysiology for sleep-disordered breathing in patients with chronic obstructive pulmonary disease. An official American thoracic society research statement. American Journal of Respiratory and Critical Care Medicine. 2018;197(3):289-299.
6. 6. Kendzerska T, Leung RS, Aaron SD, Ayas N, Sandoz JS, Gershon AS. Cardiovascular outcomes and all-cause mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease (overlap syndrome). Annals of the American Thoracic Society 2019;16(1):71-81.
7. 7. Ioachimescu OC, Janocko NJ, Ciavatta MM, Howard M, Warnock MV. Obstructive Lung Disease and Obstructive Sleep Apnea (OLDOSA) cohort study: 10-year assessment. Journal of Clinical Sleep Medicine : JCSM : Official American Academy of Sleep Medicine Publication. 2020;16(2):267-277.
8. 8. Sterling KL, Pépin JL, Linde-Zwirble W, Chen J, Benjafield AV, Cistulli PA, et al. Impact of positive airway pressure therapy adherence on outcomes in patients with obstructive sleep apnea and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 2022;206(2):197-205.

9. 9. Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, et al. Improving lung health in low-income and middleincome countries: from challenges to solutions. The Lancet. 2021;397(10277):928-940.
10. 10. Van Zeller M, Basoglu OK, Verbraecken J, Lombardi C, McNicholas WT, Pepin JL, et al. Sleep and cardiometabolic comorbidities in the obstructive sleep apnoea-COPD overlap syndrome: data from the European Sleep Apnoea Database. ERJ Open Res. 2023;9(3): 00676-2022.
11. 11. Papaioannou AI, Fouka E, Nena E, Bakakos P, Steiropoulos P. Patient-reported outcome measurements in patients with COPDobstructive sleep apnea overlap syndrome: Time for Action? Journal of Personalized Medicine. 2022;12(12):1951.
12. 12. Guilleminault C, Cummiskey J, Motta J. Chronic obstructive airflow disease and sleep studies. The American Review of Respiratory Disease. 1980;122(3):397-406.
13. 13. Owens RL, Malhotra A. Sleep-disordered breathing and COPD: the overlap syndrome. Respiratory Care. 2010;55(10):1333-44; discussion 44-46.
14. 14. Beaudin AE, Raneri JK, Ayas NT, Skomro RP, Smith EE, Hanly PJ. Contribution of hypercapnia to cognitive impairment in severe sleep-disordered breathing. J Clin Sleep Med. 2022;18(1):245-254.
15. 15. Sandek K, Andersson T, Bratel T, Hellström G, Lagerstrand L. Sleep quality, carbon dioxide responsiveness and hypoxaemic patterns in nocturnal hypoxaemia due to chronic obstructive pulmonary disease (COPD) without daytime hypoxaemia. Respiratory Medicine. 1999;93(2):79-87.
16. 16. Grassion L, Gonzalez-Bermejo J, Arnulf I, Patout M. Diagnosing sleep disordered breathing in patients with chronic pulmonary disease: which test for which patient? Breathe. 2023;19(1):220199.
17. 17. Lewis CA, Fergusson W, Eaton T, Zeng I, Kolbe J. Isolated nocturnal desaturation in COPD: Prevalence and impact on quality of life and sleep. Thorax. 2009;64(2):133-138.
18. 18. Alford NJ, Fletcher EC, Nickeson D. Acute oxygen in patients with sleep apnea and COPD. Chest. 1986;89(1):30-38.
19. 19. Calverley PM, Brezinova V, Douglas NJ, Catterall JR, Flenley DC. The effect of oxygenation on sleep quality in chronic bronchitis and emphysema. The American Review of Respiratory Disease. 1982;126(2):206-210.
20. 20. Owens RL, Derom E, Ambrosino N. Supplemental oxygen and noninvasive ventilation. European Respiratory Review. 2023;32(167):220159.
21. 21. Xu J, Wei Z, Wang X, Li X, Wang W. The risk of cardiovascular and cerebrovascular disease in overlap syndrome: a meta-analysis. J Clin Sleep Med. 2020;16(7):1199-1207.
22. 22. Shawon MS, Perret JL, Senaratna CV, Lodge C, Hamilton GS, Dharmage SC. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review. Sleep Med Rev. 2017;32:58-68.
23. 23. Warnken-Miralles MD, López-García F, Zamora-Molina L, Soler-Sempere MJ, Padilla-Navas I, García-Pachón E. Sarcopenia index in hospitalized patients with chronic obstructive pulmonary disease exacerbation. Medicina. 2021;81(3):323-328.
24. 24. Cavaillès A, Brinchault-Rabin G, Dixmier A, Goupil F, GutGobert C, Marchand-Adam S, et al. Comorbidities of COPD. European Respiratory Review: An Official Journal of the European Respiratory Society. 2013;22(130):454-475.
25. 25. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European Consensus on definition and diagnosis. Age and Ageing. 2019;48(1):16-31.
26. 26. Jaitovich A, Barreiro E. Skeletal Muscle dysfunction in chronic obstructive pulmonary disease. What we know and can do for our patients. American Journal of Respiratory and Critical Care Medicine. 2018;198(2):175-186.
27. 27. Evans RA, Morgan MD. The systemic nature of chronic lung disease. Clinics in Chest Medicine. 2014;35(2):283-293.
28. 28. Amra B, Rahmati B, Soltaninejad F, Feizi A. Screening questionnaires for obstructive sleep apnea: An updated systematic review. Oman Medical Journal. 2018;33(3):184-192.