Abstract
Purpose
The association of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), defined overlap syndrome by Flenley, is frequent.
Aims of the present study were to assess the frequency of overlap syndrome in 168 consecutive OSA patients, and to evaluate the functional pulmonary hemodynamic, and polysomnographic consequences of this association by comparing Overlap patients with OSA patients.
Methods
From the results of the pulmonary and polysomnographic investigation, patients were classified as OSA patients (group 1), having an apneas/hypopneas index (AH/I) > 15/hr, and Overlap patients (group 2), i. e. OSA patients with an obstructive spirographic pattern (FEV1<60%, FEV1/FVC<65%, RV>130%, RV/TLC>140% of predicted value) not reversible after beta2 agonist inhalation.
Group 1 consisted of 135 Patients (115 males, 20 females, age 56+/-10 yr, BMI 32+/-6 Kg/m2); the group 2 included 33 patients (30 males, 3 females, age 56+/-11 yr., BMI 34 +/- 6 Kg/m2).
Results
The OSA and Overlap patients were similar in most respects: age, BMI, clinical characteristic. In awake Overlap patients had lower PaO2, higher PaCO2 and Ppa (p<0.001), and an obstructive spirographic pattern, as compared to OSA patients. During sleep the overlap group had a higher AH/I and a lower mean SaO2 (p<0.05), a reduction of the sleep efficency (p<0.05), and a reduction in the duration of 1NREM and REM sleep stage (p<0.05), as compared to group 1.
Conclusion
In conclusion, an associated COPD is observed in more than 19% of OSA patients. Overlap patients are at increased risk of developing pulmonary hypertension and show a poorer quality of sleep as compared with OSA patients. The possibility of developing cor pulmonale should be given particular attention in the diagnosis and follow-up of Overlap patients.
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References
Higgins M.W., Thom T.: Incidence, prevalence, and mortality: intra-and inter-country differences. IN: Hansley M. J. and Saunders N. A., Eds. Clinical epidemiology of chronic obstructive pulmonary disease. Dekker M., New York, 1990, 23–43.
Franceschi M., Zamproni P., Crippa D., Smirne S.: Excessive daytime sleepines: a 1 year study in an unselected inpatient population. Sleep 1982; 5: 239–47.
Cirignotta F., D’Alessandro R., Partinen M.: Prevalence of every night snoring and obstructive sleep apneas among 30–60 year old men in Bologna Italy. Acta Neurol. Scand. 1989; 79:366–72.
Ferini-Strambi L., Zucconi M., Palazzi S., Castronovo V., Oldani A., Dalla Marca G., Smirne S.: Snoring and nocturnal oxygen desaturation in a Italian middle-aged male population. Chest 1994; 105: 1759–64.
Gislason T., Almqvist M., Eriksson G., Tanbe A., Boman E.: Prevalence of sleep apnea syndrome among Swedish men: an epidemiological study. J. Clin. Epidemiol. 1988; 41: 571–76.
Flenley D.C.: Sleep in chronic obstructive lung disease. Clin. Chest Med. 1985; 6: 651–61.
Chaouat A., Weitzenblum E., Krieger J., Ifoundza T., Oswald M., Kessel R.: Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am. J. Respir. Crit. Care. 1995; 151: 82–5.
Weitzenblum E., Krieger J., Apprill M., Valle E., Ehrhart M., Ratomaharo J., Oswald M., Kurtz D.: Daytime pulmonary hypertension in Patients with obstructive sleep apnea syndrome. Am. Rev. Resp. Dis. 1988; 138:345–49.
Krieger J., Sforza E., Apprill M., Lampert E., Weitzenblum E., Rotomaharo J.: Pulmonary hypertension, hypoxemia, and hypercapnia in obstrutive sleep apnea Patients. Chest 1989; 96: 729–37.
Kump K., Whalen C., Thshler P.W., Crowner I., Ferrette V., Strohl P.W., Rosemberg K., Redling S.: Assesment of the validity and utility of a sleep-symptom questionnaire. Am. J. Crit. Care Med. 1994; 150: 735–41.
Rechtshaffen A., Kales A. (eds.): A normal of standardized terminology, techniques and scoring system for sleep stages of human subjects. Washington, D.C.: Governement Printing Office, 1968 (NIH publication no 204).
Guilleminault C., Tilkian A., Dement W.C.: The sleep apnea syndrome. Am. Rev. Med. 1976; 27: 465–84.
EEG Arousal: scoring rules and examples. A preliminary report from the sleep disorders atlas task force of the American Sleep Disorders Association. Sleep 1992; 15: 173–84.
Quanyer P.H., Tammeling G.J., Cotes J.E., Pedersen O.F., Peslin R., Yernault J.C.: Lung volumes and forced ventilatory flows. Eur. Respir. J. 1993; 6 (suppl. 16): 5–40.
Laks L., Lehrhaft B., Grunstein R.R., Sullivan C.E.: Pulmonary hypertension in obstructive sleep Apnea. Eur. Respir. J. 1995; 8: 537–41.
Chaouat A., Weitzenblum E., Krieger J., Oswald M., Kessler R.: Pulmonary Hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest 1996; 109: 380–86.
Sajkov D., Cowie R.J., Thornton A.T., Espinoza H.A., McEvoy R.D.: Pulmonary Hypertension and Hypoxemia in obstructive sleep apnea syndrome. Am. J. Respir. Crit. Care Med. 1994; 149: 416–22.
Bradley T.D., Martinez D., Rutherford R., Lue F., Grossman R., Moldofsky H., Zamel N., Phillipson A.: Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. J. Appl. Physiol. 1985; 59: 1364–68.
Flectcher E.C., Costarangos C., Miller T.: The rate of fall of arterial oxyhemoglobin saturation in obstructive sleep apnea. Chest 1989; 96:717–22.
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Rizzi, M., Palma, P., Andreoli, A. et al. Prevalence and clinical feature of the “overlap syndrome”, obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), in OSA population. Sleep & Breathing 2, 68–72 (1997). https://doi.org/10.1007/BF03038868
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DOI: https://doi.org/10.1007/BF03038868