High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease

• Published in: Annals of the American Thoracic Society Vol. 12; no. 8; pp. 1219 - 1225
• Main Authors: Soler, Xavier, Gaio, Eduardo, Powell, Frank L, Ramsdell, Joe W, Loredo, Jose S, Malhotra, Atul, Ries, Andrew L
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.08.2015
• Subjects: Aged; Female; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Original Research; Oxygen - therapeutic use; Polysomnography - methods; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Quality of Life; Severity of Illness Index; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - epidemiology; Surveys and Questionnaires; obstructive sleep apnea; overlap; pulmonary rehabilitation; sleep-disordered breathing; chronic obstructive pulmonary disease
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/AnnalsATS.201407-336OC

When obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) coexist in the so-called "overlap" syndrome, a high risk for mortality and morbidity has been reported. There is controversy about the prevalence of OSA in people affected by COPD. The purpose of this study was to investigate objective meaures of sleep-disordered breathing in patients with moderate to severe COPD to test the hypothesis that COPD is associated with an increased prevalence of OSA. Fifty-four patients (54% men) with moderate to severe COPD were enrolled prospectively (mean ± SD, FEV1 = 42.8 ± 19.8% predicted, and FEV1/FVC = 42.3 ± 13.1). Twenty patients (37%) were on supplemental oxygen at baseline. Exercise tolerance; questionnaires related to symptoms, sleep, and quality of life; and home polysomnography were obtained. Forty-four patients had full polysomnography suitable for analysis. OSA (apnea-hypopnea index > 5/h) was present in 29 subjects (65.9%). Sleep efficiency was poor in 45% of subjects. OSA is highly prevalent in patients with moderate to severe COPD referred to pulmonary rehabilitation. Sleep quality is also poor among this selected group. These patients have greater-than-expected sleep-disordered breathing, which could be an important contributory factor to morbidity and mortality. Pulmonary rehabilitation programs should consider including a sleep assessment in patients with moderate to severe COPD and interventions when indicated to help reduce the impact of OSA in COPD.