Effect of lung function on the apnea-hypopnea index in patients with overlap syndrome: a multicenter cross-sectional study

  • Jing Zhu
  • Zhiling Zhao
  • Qingrong Nie
  • Yingnan Wang
  • Zhen Fu
  • Xiheng Guo
  • Ke HuEmail author
Sleep Breathing Physiology and Disorders • Original Article



Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are referred to as having overlap syndrome (OVS). However, the relationship of lung function with the apnea-hypopnea index (AHI) in patients with OVS has not been evaluated. This multicenter study aimed to evaluate the relationship.


COPD patients diagnosed by spirometry were recruited from four Chinese tertiary hospitals. Those patients were requested to attend an overnight polysomnography (PSG). The relationships between parameters of lung function and sleep respiration in patients with OVS were assessed using multiple regression analyses.


A total of 520 OVS patients and 246 patients with COPD only finally met inclusion criteria for study. After adjustment for age, sex, body mass index, neck circumference, economic status, smoking status, alcohol consumption, and hypertension, the forced expiratory volume in the first second (FEV1) had a positive correlation with the AHI in patients with OVS (β, 0.17; 95% CI, 0.06–0.28; P < 0.01). However, when the severity of lung function of patients with OVS was stratified, the correlation with the FEV1 of each grade and the AHI was absent (P > 0.05). Additionally, The FEV1 was positively correlated with the nadir oxygen saturation (SaO2) (β, 0.18; 95% CI, 0.08–0.27; P < 0.01) and was negatively correlated with the percentage of time spent with an SaO2 below 90% (TS90%) (β,− 0.41; 95% CI,− 0.61–0.21; P < 0.01) in patients with OVS using multiple regression analyses.


Lung function was associated with the AHI in patients with OVS. The lower FEV1 may play some protective role in the severity of AHI in OVS patients.

Trial, No.: NCT 03182309, URL:


Chronic obstructive pulmonary disease Obstructive sleep apnea Overlap syndrome Lung function Apnea-hypopnea index 



This work was supported by the National Key Research and Development Program of China (project number: 2016YFC1304403).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research protocol was approved by the Ethics Committee of each center and has been performed in accordance with the 1964 Helsinki declaration and its later amendments.

Statement of informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Respiratory and Critical Care MedicineRenmin Hospital of Wuhan UniversityWuhanChina
  2. 2.Department of Respiratory and Critical Care MedicineThe People’s Hospital of China Three Gorges UniversityYichangChina
  3. 3.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
  4. 4.Division of Respiratory Disease, Liangxiang Hospital of Yanjing Medical CollegeCapital Medical UniversityBeijingChina
  5. 5.Department of Respiratory and Critical Care MedicineThe People’s Hospital of China Three Gorges UniversityYichangChina
  6. 6.Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  7. 7.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
  8. 8.Department of Respiratory and Critical Care MedicineRenmin Hospital of Wuhan UniversityWuhanChina

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