Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review

• Published in: Sleep medicine reviews Vol. 32; pp. 58 - 68
• Main Authors: Shawon, Md Shajedur R., Perret, Jennifer L., Senaratna, Chamara V., Lodge, Caroline, Hamilton, Garun S., Dharmage, Shyamali C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2017
• Subjects: Cardiovascular Diseases; Chronic obstructive pulmonary disease (COPD); Clinical outcome; Comorbidity; Humans; Neurology; Nocturnal oxygen desaturation (NOD); Obstructive sleep apnea (OSA); Overlap syndrome; Polysomnography; Polysomnography - methods; Prevalence; Pulmonary Disease, Chronic Obstructive - epidemiology; Quality of Life; Sleep Apnea, Obstructive - epidemiology; Sleep Medicine; Chronic obstructive pulmonary disease (COPD); Clinical outcome; Prevalence; Nocturnal oxygen desaturation (NOD); Obstructive sleep apnea (OSA); Overlap syndrome; Polysomnography; AHI; arterial oxygen saturation; forced vital capacity; HR; odds ratio; chronic obstructive pulmonary disease (COPD); forced expiratory volume in 1 st second; MOOSE; meta-analysis of observational studies in epidemiology; MeSH; total sleep time spent with SpO 2 < 90; apnea-hypopnea index; continuous positive airway pressure; medical subject headings; GERD; clinical outcome; obstructive sleep apnea (OSA); FEV1; gastro esophageal reflux disorder; quality of life; CRP; GOLD; SpO 2; CPAP; SaO 2; QoL; prevalence; American academy of sleep medicine; polysomnography; OSA; obstructive sleep apnea; OR; AASM; ESS; CI; peripheral capillary oxygen saturation; c-reactive protein; T90; ICD; nocturnal oxygen desaturation (NOD); global initiative for chronic obstructive lung disease; FVC; hazard ratio; confidence interval; COPD; chronic obstructive pulmonary disease; Epworth sleepiness scale; international classification of diseases
• ISSN: 1087-0792; 1532-2955
• DOI: 10.1016/j.smrv.2016.02.007

The objective of this systematic review is to synthesize the evidence on prevalence, polysomnographic findings and clinical outcomes of co-morbid obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) – known as the “overlap syndrome”. We systematically searched PubMed on 1 December 2015 using appropriate medical subject headings (MeSH) and text words to capture prevalence studies and comparative studies of any observational design examining the clinical outcomes in patients with co-existent COPD and OSA. We reviewed 591 articles and included 27 in the final review. In total, 21 observational studies (n = 29,341 participants) provided prevalence estimates. Overlap syndrome is not common in the general and hospital population (range: 1.0–3.6%), but is highly prevalent in patients diagnosed with either obstructive sleep apnea (range: 7.6–55.7%) or COPD (range: 2.9–65.9%). Overlap syndrome patients have been shown to have greater nocturnal oxygen desaturation (NOD) (i.e., reduced mean peripheral capillary oxygen saturation (SpO2) and increased sleep time spent with SpO2 < 90% (T90)) and worse sleep quality than patients with only OSA. It is associated with more frequent cardiovascular morbidity, poorer quality of life (QoL), more frequent COPD exacerbation and increased medical costs. This systematic review on overlap syndrome highlights the limitations and knowledge gaps of its prevalence, etiology and underlying pathophysiologic mechanisms related to increased morbidity and mortality.