Polysomnographic features of low arousal threshold in overlap syndrome involving obstructive sleep apnea and chronic obstructive pulmonary disease

  • Yasuhiro YamaguchiEmail author
  • Satomi Shiota
  • Yuji Kusunoki
  • Hironobu Hamaya
  • Masaki Ishii
  • Yuzo Kodama
  • Masahiro Akishita
  • Kozui Kida
  • Kazuhisa Takahashi
  • Takahide Nagase
  • Yoshinosuke Fukuchi
Sleep Breathing Physiology and Disorders • Original Article



In patients with overlap syndrome (OVS), the pathophysiologies of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease can interact with one another. Focusing on low arousal threshold, the authors evaluated polysomnographic features of OVS patients.


This retrospective, multicenter study was conducted at three hospitals in Japan. Patients aged ≥ 60 years who underwent polysomnography and pulmonary function testing were reviewed. Severity of airflow limitation (AFL) was classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Low arousal threshold was predicted based on the following polysomnography features: lower apnea-hypopnea index (AHI); higher nadir oxygen saturation, and larger hypopnea fraction of total respiratory events. These features were compared among patients with only OSA (n = 126), OVS with mild AFL (n = 16), and OVS with moderate/severe AFL (n = 22).


A low arousal threshold was more frequently exhibited by OVS patients with moderate/severe AFL than by those with OSA only (p = 0.016) and OVS with mild AFL (p = 0.026). As forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decreased in OVS patients, the mean length of apnea decreased (r = 0.388, p = 0.016), hypopnea fractions increased (r = − 0.337, p = 0.039), and AHI decreased (r = 0.424, p = 0.008). FEV1/FVC contributed to low arousal threshold independent of age, sex, smoking history, hospital, or body mass index in all subjects (OR 0.946 [95% CI 0.909–0.984]) and in OVS patients (OR 0.799 [95% CI 0.679–0.940]).


This study first described peculiar polysomnographic features in OVS patients with moderate/severe AFL, suggesting a high prevalence of low arousal threshold.


Arousal Chronic obstructive pulmonary disease Obstructive sleep apnea Polysomnography Spirometry 



We thank Dr. Takeo Ishii from GlaxoSmithKline for helpful discussion while he was a member of the Respiratory Care clinic.


The present study was supported by GOLD-Jac.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Given the retrospective nature of the study and the use of anonymized patient data, formal consent is not required.

Supplementary material

11325_2019_1786_MOESM1_ESM.pdf (159 kb)
ESM 1 (PDF 159 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yasuhiro Yamaguchi
    • 1
    Email author
  • Satomi Shiota
    • 2
  • Yuji Kusunoki
    • 3
  • Hironobu Hamaya
    • 1
  • Masaki Ishii
    • 1
  • Yuzo Kodama
    • 2
  • Masahiro Akishita
    • 1
  • Kozui Kida
    • 3
  • Kazuhisa Takahashi
    • 2
  • Takahide Nagase
    • 4
  • Yoshinosuke Fukuchi
    • 2
  1. 1.Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Respiratory MedicineJuntendo University Faculty of Medicine and Graduate School of MedicineTokyoJapan
  3. 3.Respiratory Care Clinic, Department of Respiratory MedicineNippon Medical SchoolTokyoJapan
  4. 4.Department of Respiratory Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan

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