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van Zeller M, McNicholas WT. Sleep disordered breathing: OSA-COPD overlap. Expert Rev Respir Med 2024:1-11. [PMID: 38932721 DOI: 10.1080/17476348.2024.2373790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/25/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Sleep has important effects on breathing and gas exchange that may have negative consequences in patients with chronic obstructive pulmonary disease (COPD). COPD and obstructive sleep apnea (OSA) are highly prevalent and may coexist, which is referred to as the overlap syndrome. AREAS COVERED The probability of OSA-COPD overlap represents the balance of protective and promoting factors such as hyperinflation and fluid retention; thus, different clinical COPD phenotypes influence the likelihood of comorbid OSA. The clinical presentation of OSA-COPD overlap is nonspecific, and the diagnosis requires clinical awareness to identify patients needing overnight studies. Both COPD and OSA are associated with a range of overlapping physiological and biological disturbances including hypoxia and inflammation that contribute to cardiovascular comorbidities. The management of OSA-COPD overlap patients differs from those with COPD alone and the survival of overlap patients treated with positive airway pressure (PAP) is superior to those untreated. EXPERT OPINION The recognition of OSA-COPD overlap has important clinical relevance because of its impact on outcomes and management. Management of the overlap should address both sleep quality and disordered gas exchange. PAP therapy has demonstrated reductions in COPD exacerbations, hospitalizations, healthcare costs and mortality in overlap patients.
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Affiliation(s)
- Mafalda van Zeller
- Respiratory Department and Sleep and Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Walter T McNicholas
- School of Medicine and The Conway Research Institute, University College Dublin, Dublin, Ireland
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
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Self AA, Mesarwi OA. Intermittent Versus Sustained Hypoxemia from Sleep-disordered Breathing: Outcomes in Patients with Chronic Lung Disease and High Altitude. Sleep Med Clin 2024; 19:327-337. [PMID: 38692756 DOI: 10.1016/j.jsmc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
In a variety of physiologic and pathologic states, people may experience both chronic sustained hypoxemia and intermittent hypoxemia ("combined" or "overlap" hypoxemia). In general, hypoxemia in such instances predicts a variety of maladaptive outcomes, including excess cardiovascular disease or mortality. However, hypoxemia may be one of the myriad phenotypic effects in such states, making it difficult to ascertain whether adverse outcomes are primarily driven by hypoxemia, and if so, whether these effects are due to intermittent versus sustained hypoxemia.
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Affiliation(s)
- Alyssa A Self
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, University of California, San Diego, 9500 Gilman Drive Mail Code 0623A, La Jolla, CA 92093, USA
| | - Omar A Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, University of California, San Diego, 9500 Gilman Drive Mail Code 0623A, La Jolla, CA 92093, USA.
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McNicholas WT. Does Obstructive Sleep Apnea Lead to Progression of Chronic Obstructive Pulmonary Disease. Sleep Med Clin 2024; 19:253-260. [PMID: 38692750 DOI: 10.1016/j.jsmc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have important bidirectional relationships that influence the pathophysiology of each disorder. The slim hyperinflated "pink puffer" phenotype of COPD protects against OSA, whereas the heavier "blue bloater" phenotype predisposes to OSA by fluid retention. OSA may aggravate COPD by promoting airway inflammation. COPD-OSA overlap patients have lower quality of life and are at higher risk of cardiovascular comorbidity than either disorder alone due to greater nocturnal oxygen desaturation and sympathetic activation. Management of OSA with positive airway pressure improves COPD outcomes that include lower exacerbation rates compared to untreated patients.
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Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland; School of Medicine and the Conway Research Institute, University College, Dublin, Ireland.
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Fanaridis M, Bouloukaki I, Stathakis G, Steiropoulos P, Tzanakis N, Moniaki V, Mavroudi E, Tsiligianni I, Schiza S. Prevalence and Characteristics of Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: Overlap Syndrome. Life (Basel) 2024; 14:547. [PMID: 38792569 PMCID: PMC11122385 DOI: 10.3390/life14050547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Overlap syndrome (OVS) is a distinct clinical entity that seems to result in potential cardiovascular consequences. We aimed to estimate the prevalence and risk factors for OVS in OSA patients and analyze clinical and PSG characteristics associated with OVS. In this cross-sectional study, 2616 patients evaluated for OSA underwent type-1 polysomnography (PSG). They were grouped as pure OSA (AHI > 15/h) and OVS patients. Demographics, PSG data, pulmonary function tests and arterial blood gases (ABGs) were compared between groups after adjustments for confounders. OSA was diagnosed in 2108 out of 2616 patients. Of those, 398 (19%) had OVS. Independent predictors of OVS were older age [OR: 5.386 (4.153-6.987)], current/former smoking [OR: 11.577 (7.232-18.532)], BMI [OR: 2.901 (2.082-4.044)] and ABG measurements [PaCO2 ≥ 45 OR: 4.648 (3.078-7.019), PO2 [OR: 0.934 (0.920-0.949)], HCO3- [OR: 1.196 (1.133-1.263), all p < 0.001]. OVS was also associated with prevalent hypertension [OR: 1.345 (1.030-1.758), p = 0.03] and cardiovascular disease [OR: 1.617 (1.229-2.126), p < 0.001], depressive symptoms [OR: 1.741 (1.230-2.465), p = 0.002] and nocturia [OR: 1.944 (1.378-2.742), p < 0.001], as well as with indices of OSA severity. Disturbances in sleep architecture were more prominent in OVS expressed by lower %N3 and REM% and higher arousal index. Our data suggest that OVS is prevalent among OSA patients, with distinct clinical and PSG characteristics. These characteristics could be utilized as predictive factors for early identification and further evaluation of these patients towards desirable patient-reported outcomes.
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Affiliation(s)
- Michail Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
- Department of Social Medicine, School of Medicine, University of Crete, 71410 Heraklion, Greece;
| | - Georgios Stathakis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, 68100 Alexandroupolis, Greece;
| | - Nikos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Eleni Mavroudi
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
| | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, 71410 Heraklion, Greece;
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.F.); (G.S.); (V.M.); (E.M.); (S.S.)
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Yeh YL, Lai CM, Liu HP. Outcomes of coronary artery bypass grafting (CABG) in patients with OSA-COPD overlap syndrome versus COPD alone: an analysis of US Nationwide Inpatient Sample. BMC Pulm Med 2024; 24:171. [PMID: 38589824 PMCID: PMC11003138 DOI: 10.1186/s12890-024-02994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are associated with unfavorable outcomes following coronary artery bypass grafting (CABG). The purpose of this study was to compare in-hospital outcomes of patients with COPD alone versus OSA-COPD overlap after CABG. METHODS Data of adults ≥ 18 years old with COPD who received elective CABG between 2005 and 2018 were extracted from the US Nationwide Inpatient Sample (NIS). Patients were divided into two groups: with OSA-COPD overlap and COPD alone. Propensity score matching (PSM) was employed to balance the between-group characteristics. Logistic and linear regression analyses determined the associations between study variables and inpatient outcomes. RESULTS After PSM, data of 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed. After adjustment, OSA-COPD overlap was associated with a significantly increased risk of overall postoperative complications (adjusted odd ratio [aOR] = 1.12, 95% confidence interval [CI]: 95% CI: 1.01-1.24), respiratory failure/prolonged mechanical ventilation (aOR = 1.27, 95%CI: 1.14-1.41), and non-routine discharge (aOR = 1.16, 95%CI: 1.03-1.29), and AKI (aOR = 1.14, 95% CI: 1.00-1.29). Patients with OSA-COPD overlap had a lower risk of in-hospital mortality (adjusted odd ratio [aOR] = 0.53, 95% CI: 0.35-0.81) than those with COPD only. Pneumonia or postoperative atrial fibrillation (AF) risks were not significantly different between the 2 groups. Stratified analyses revealed that, compared to COPD alone, OSA-COPD overlap was associated with increased respiratory failure/prolonged mechanical ventilation risks among patients ≥ 60 years, and both obese and non-obese subgroups. In addition, OSA-COPD overlap was associated with increased risk of AKI among the older and obese subgroups. CONCLUSION In US adults who undergo CABG, compared to COPD alone, those with OSA-COPD are at higher risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation, but a lower in-hospital mortality. No increased risk of AF was noted.
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Affiliation(s)
- Yen-Liang Yeh
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Force General Hospital, No. 2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan (R.O.C.).
| | - Chien-Ming Lai
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Force General Hospital, No. 2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan (R.O.C.)
| | - Hui-Pu Liu
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Force General Hospital, No. 2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan (R.O.C.)
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Polman R, Hurst JR, Uysal OF, Mandal S, Linz D, Simons S. Cardiovascular disease and risk in COPD: a state of the art review. Expert Rev Cardiovasc Ther 2024; 22:177-191. [PMID: 38529639 DOI: 10.1080/14779072.2024.2333786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited. AREAS COVERED 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD. EXPERT OPINION The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2023.
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Affiliation(s)
- Ricardo Polman
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | | | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
| | - Dominik Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Sami Simons
- Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
- Department of Respiratory Medicine, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Kang J, Park HK, Koo HK, Kang HK, Seo WJ, Kang J, Lee SS. Estimating the prevalence and clinical significance of chronic obstructive pulmonary disease-obstructive sleep apnea overlap in South Korea. Sleep Med 2024; 114:237-243. [PMID: 38237411 DOI: 10.1016/j.sleep.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Concurrent obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are referred to as COPD-OSA overlap. We investigated the prevalence and clinical significance of COPD-OSA overlap in the general population of South Korea. METHODS Data were obtained from the 2019 Korea National Health and Nutrition Examination Survey. Participants ≥40 years of age with complete STOP-Bang questionnaire and spirometry data were included. OSA was presumed in individuals with a STOP-Bang score of ≥3. COPD was determined using forced expiratory volume at 1 s/forced vital capacity <0.7. Participants were classified on the basis of the STOP-Bang score and spirometry findings. Clinical characteristics, comorbidities, and quality of life (using the EuroQoL 5-dimension instrument) were compared between the overlap group and COPD-alone or OSA-alone groups. RESULTS Among the 3157 participants, 6.9 % demonstrated COPD-OSA overlap. Individuals with OSA alone and COPD alone were 31.8 % and 5.2 %, respectively. The overlap group included more males, ever smokers, and frequent alcohol drinkers than the COPD- or OSA-alone groups. The overlap group had more diagnoses of hypertension, diabetes, and stroke than the COPD-alone group. The risk of anxiety/depression was approximately 2.5 times higher in the overlap group than in the COPD-alone group. COPD-OSA overlap was a significant risk factor for anxiety/depression after adjusting for age, sex, household income, and education levels. CONCLUSION COPD-OSA overlap is not rare within the general population of South Korea. Patients with overlap showed more comorbidities and higher levels of anxiety/depression than those in the COPD-alone group.
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Affiliation(s)
- Jieun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea.
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Woo Jung Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, South Korea
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Schiza S, Schwarz EI, Bonsignore MR, McNicholas WT, Pataka A, Bouloukaki I. Co-existence of OSA and respiratory diseases and the influence of gender. Expert Rev Respir Med 2023; 17:1221-1235. [PMID: 38198636 DOI: 10.1080/17476348.2024.2304065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease. AREAS COVERED This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations. EXPERT OPINION Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich and University of Zurich, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Department, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Medical School, Aristoteleio Panepistemio Thessalonikes Schole Epistemon Ygeias, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
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Du D, Zhang G, Xu D, Liu L, Hu X, Chen L, Li X, Shen Y, Wen F. Prevalence and clinical characteristics of sleep disorders in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Sleep Med 2023; 112:282-290. [PMID: 37950939 DOI: 10.1016/j.sleep.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Sleep disorders, including obstructive sleep apnea (OSA), restless leg syndrome (RLS) and insomnia, are present in chronic obstructive pulmonary disease (COPD) with varied prevalence. The aim of this systematic review and meta-analysis was to investigate prevalence of OSA, RLS and insomnia in patients with COPD and summarize their clinical characteristics. METHODS We searched PubMed, Web of Science and Scopus for eligible articles reporting the prevalence of OSA, RLS, and insomnia in COPD patients. The Newcastle‒Ottawa scale was applied for quality assessment. Odds ratios or mean differences with 95 % confidence intervals (CIs) were applied for the overall prevalence calculation and clinical characteristics assessment. Sensitivity analysis, subgroup analysis and meta-regression were conducted to evaluate the heterogeneity of the results. RESULTS Sixty articles reporting the prevalence of sleep disorders in patients with COPD were included, and the prevalence of OSA, RLS, and insomnia reached 29.1 %(95%CI 27.2%-30.9 %), 21.6 %(95%CI 11.8%-33.3 %) and 29.5 %(95%CI 16.9%-44.0 %), respectively. COPD patients with OSA were characterized by male sex (OR 1.631 95 % CI: 1.231-2.161), obesity(kg/m2) (MD 4.435, 95 % CI 3.218-5.652), higher Epworth Sleepiness Scale (MD: 3.741, 95 % CI: 0.655-6.828, p = 0.018), better pulmonary function (MD 5.66, 95 % CI 3.546-7.774) and higher risks of hypertension (OR 1.933 95 % CI 1.382-2.70) and diabetes (OR 1.898 95 % CI 1.264-2.849). COPD patients with RLS were associated with a higher Epworth sleepiness scale (ESS) score (MD 3.444, 95 % CI 1.880-5.008) and a longer COPD duration(year) (MD: 3.656, 95 % CI: 2.209-5.103). COPD patients with insomnia were characterized by female sex(OR 0.556, 95%CI 0.545,0.567, p < 0.001). CONCLUSION Our study suggests that OSA, RLS and insomnia are common in COPD patients with specific clinical characteristics. Further studies are needed to explore the interactions between COPD and sleep disorders.
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Affiliation(s)
- Dongru Du
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China; West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Guangyue Zhang
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Xu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Lian Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Xueru Hu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Lei Chen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Xiaoou Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Yongchun Shen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Fuqiang Wen
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
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Voulgaris A, Archontogeorgis K, Apessos I, Paxinou N, Nena E, Steiropoulos P. Is COPD the Determinant Factor for Myocardial Injury and Cardiac Wall Stress in OSA Patients? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1759. [PMID: 37893477 PMCID: PMC10608258 DOI: 10.3390/medicina59101759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Evidence shows that COPD-OSA overlap syndrome (OS) is more frequently accompanied by cardiovascular disease (CVD) in comparison to either disease alone. The aim of the study was to explore whether patients with OS have a higher burden of subclinical myocardial injury and wall stress compared with OSA patients. Materials and Methods: Consecutive patients, without established CVD, underwent polysomnography and pulmonary function testing, due to suspected sleep-disordered breathing. An equal number of patients with OS (n = 53, with an apnea hypopnea index (AHI) > 5/h and FEV1/FVC < 0.7) and patients with OSA (n = 53, AHI > 5/h and FEV1/FVC > 0.7) were included in the study. The detection of asymptomatic myocardial injury and wall stress was performed via the assessment of serum high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), respectively. Results: OS patients were older (p < 0.001) and had worse hypoxemic parameters, namely average oxyhemoglobin saturation (SpO2) (p = 0.002) and time spent with SpO2 < 90% (p = 0.003) during sleep as well as daytime pO2 (p < 0.001), than patients with OSA. No difference was observed between groups in terms of Epworth Sleepiness Scale (p = 0.432) and AHI (p = 0.587). Both levels of hs-cTnT (14.2 (9.1-20.2) vs. 6.5 (5.6-8.7) pg/mL, p < 0.001) and NT-proBNP (93.1 (37.9-182.5) vs. 19.2 (8.3-35.4) pg/mL, p < 0.001) were increased in OS compared to OSA patients. Upon multivariate linear regression analysis, levels of NT-proBNP and hs-cTnT correlated with age and average SpO2 during sleep. Conclusions: Our study demonstrated higher levels of hs-cTnT and NT-proBNP in OS patients, indicating an increased probability of subclinical myocardial injury and wall stress, compared with OSA individuals.
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Affiliation(s)
- Athanasios Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (N.P.); (P.S.)
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Kostas Archontogeorgis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (N.P.); (P.S.)
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Ioulianos Apessos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
- Department of Dentoalveolar Surgery, Implantology and Oral Radiology, School of Dentistry, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
| | - Nikoleta Paxinou
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (N.P.); (P.S.)
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (K.A.); (N.P.); (P.S.)
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Sanchez-Azofra A, Gu W, Masso-Silva JA, Sanz-Rubio D, Marin-Oto M, Cubero P, Gil AV, Moya EA, Barnes LA, Mesarwi OA, Marin T, Simonson TS, Crotty Alexander LE, Marin JM, Malhotra A. Inflammation biomarkers in OSA, chronic obstructive pulmonary disease, and chronic obstructive pulmonary disease/OSA overlap syndrome. J Clin Sleep Med 2023; 19:1447-1456. [PMID: 37082823 PMCID: PMC10394367 DOI: 10.5664/jcsm.10600] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
STUDY OBJECTIVES The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in a single individual, also known as overlap syndrome (OVS), is associated with higher cardiovascular risk and mortality than either OSA or COPD alone. However, the underlying mechanisms remain unclear. We hypothesized that patients with OVS have elevated systemic inflammatory biomarkers relative to patients with either disease alone, which could explain greater cardiovascular risk observed in OVS. METHODS We included 255 participants in the study, 55 with COPD alone, 100 with OSA alone, 50 with OVS, and 50 healthy controls. All participants underwent a home sleep study, spirometry, and a blood draw for high-sensitivity C-reactive protein and total blood count analysis. In a randomly selected subset of 186 participants, inflammatory protein profiling was performed using Bio-Rad Bio-Plex Pro Human Cytokine 27-Plex Assays. Biomarker level differences across groups were identified using a mixed linear model. RESULTS Levels of interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and granulocyte colony stimulating factor (G-CSF) were higher in participants with OVS and COPD compared with healthy controls and participants with OSA. Furthermore, participants with OVS had higher circulating levels of leukocytes and neutrophils than those with COPD, OSA, and controls. CONCLUSIONS COPD and OVS are associated with higher systemic inflammation relative to OSA and healthy controls. This work proposes the potential utilization of interleukin 6, granulocyte colony stimulating factor, and high-sensitivity C-reactive protein as screening biomarkers for COPD in patients with OSA. Inflammatory pathways may not fully explain the higher cardiovascular risk observed in OVS, indicating the need for further investigation. CITATION Sanchez-Azofra A, Gu W, Masso-Silva JA, et al. Inflammation biomarkers in OSA, chronic obstructive pulmonary disease, and chronic obstructive pulmonary disease/OSA overlap syndrome. J Clin Sleep Med. 2023;19(8):1447-1456.
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Affiliation(s)
- Ana Sanchez-Azofra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Division of Pulmonary and Sleep Medicine. Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Wanjun Gu
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Herbert Wertheim School of Public Health and Longevity Sciences, University of California, San Diego, La Jolla, California
| | - Jorge A. Masso-Silva
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Section of Pulmonary and Critical Care, VA San Diego, La Jolla, California
| | - David Sanz-Rubio
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Marin-Oto
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Pablo Cubero
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana V. Gil
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Esteban A. Moya
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
| | - Laura A. Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
| | - Omar A. Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
| | - Traci Marin
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Health Sciences, Department of Respiratory Therapy, Victor Valley College, Victorville, California
| | - Tatum S. Simonson
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Center for Physiological Genomics of Low Oxygen, University of California, La Jolla, California
| | - Laura E. Crotty Alexander
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Section of Pulmonary and Critical Care, VA San Diego, La Jolla, California
| | - Jose M. Marin
- Translational Research Unit, IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
- CIBERES Instituto Salud Carlos III, and Department of Medicine, University of Zaragoza School of Medicine, Zaragoza, Spain
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, La Jolla, California
- Center for Physiological Genomics of Low Oxygen, University of California, La Jolla, California
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12
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Altay S, Fırat S, Peker Y. A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist? J Clin Med 2023; 12:4144. [PMID: 37373837 DOI: 10.3390/jcm12124144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT.
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Affiliation(s)
- Servet Altay
- Department of Cardiology, Trakya University School of Medicine, Edirne 22030, Turkey
| | - Selma Fırat
- Department of Pulmonary Medicine, University of Health Sciences, Atatürk Sanatorium Education and Research Hospital, Ankara 06280, Turkey
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22002 Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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13
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Hou X, Hu J, Wang E, Wang J, Song Z, Hu J, Shi J, Zhang C. Self-Reported Sleep Disturbance is an Independent Predictor of All-Cause Mortality and Respiratory Disease Mortality in US Adults: A Population-Based Prospective Cohort Study. Int J Public Health 2023; 68:1605538. [PMID: 36865999 PMCID: PMC9971003 DOI: 10.3389/ijph.2023.1605538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objective: Self-reported sleep disturbance is common but its association with mortality has rarely been investigated. Methods: This prospective cohort analysis included 41,257 participants enrolled in the National Health and Nutrition Examination Survey from 2005 to 2018. Self-reported sleep disturbance in the present study refers to the patients who have ever consulted doctors or other professionals for trouble sleeping. Univariate and multivariate survey-weighted Cox proportional hazards models were used to evaluate the association of self-reported sleep disturbance with all-cause and disease-specific mortality. Results: Approximately 27.0% of US adults were estimated to have self-reported sleep disturbance. After adjusting for all sociodemographic variables, health behavioral factors, and common comorbidities, participants with self-reported sleep disturbance tend to have higher all-cause mortality risk with a hazard ratio (HR) of 1.17 (95% CI, 1.04-1.32) and chronic lower respiratory disease mortality risk (HR, 1.88; 95% CI, 1.26-2.80), but not cardiovascular disease mortality risk (HR, 1.19; 95% CI, 0.96-1.46) and cancer mortality risk (HR, 1.10; 95% CI, 0.90-1.35). Conclusion: Self-reported sleep disturbance could be associated with higher mortality in adults, and may need to be paid more attention in public health management.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiajia Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Shi
- Department of Anesthesiology, Changsha Yamei Plastic Surgery Hospital, Changsha, China
| | - Chengliang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Chengliang Zhang,
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14
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Chaszczewska-Markowska M, Górna K, Bogunia-Kubik K, Brzecka A, Kosacka M. The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results. J Clin Med 2023; 12:jcm12030801. [PMID: 36769452 PMCID: PMC9918226 DOI: 10.3390/jcm12030801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. MATERIAL AND METHODS This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex® platform was used. RESULTS In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO2, low mean nocturnal SaO2, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). CONCLUSIONS In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO2 are factors contributing to the chronic inflammatory state in OSA patients.
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Affiliation(s)
- Monika Chaszczewska-Markowska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Katarzyna Górna
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
- Correspondence:
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
| | - Monika Kosacka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
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Landete P, Fernández-García CE, Muñoz JM, Friera A, Ancochea J, González-Rodríguez Á, García-Monzón C. Sleep apnea-COPD overlap syndrome is associated with larger left carotid atherosclerotic plaques. Front Cardiovasc Med 2023; 10:1104377. [PMID: 37025690 PMCID: PMC10070750 DOI: 10.3389/fcvm.2023.1104377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Background Little is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome increases the risk of stroke associated with COPD itself. Methods We prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated. Results Polygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjusted-multivariate linear regression revealed age, current smoking and the apnea/hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients. Conclusions This study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke.
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Affiliation(s)
- Pedro Landete
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Correspondence: Pedro Landete Carlos Ernesto Fernández-García
| | - Carlos Ernesto Fernández-García
- Liver Research Unit, Unidad de Investigación, Hospital Universitario Santa Cristina, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
- Correspondence: Pedro Landete Carlos Ernesto Fernández-García
| | - José M. Muñoz
- Servicio de Radiodiagnóstico Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Alfonsi Friera
- Servicio de Radiodiagnóstico Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Julio Ancochea
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Águeda González-Rodríguez
- Instituto de Investigaciones Biomédicas Alberto Sols (Centro Mixto CSIC-UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Carmelo García-Monzón
- Liver Research Unit, Unidad de Investigación, Hospital Universitario Santa Cristina, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
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16
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Bouloukaki I, Fanaridis M, Testelmans D, Pataka A, Schiza S. Overlaps between obstructive sleep apnoea and other respiratory diseases, including COPD, asthma and interstitial lung disease. Breathe (Sheff) 2022; 18:220073. [PMID: 36865659 PMCID: PMC9973497 DOI: 10.1183/20734735.0073-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
In the past, there was limited research relating to the role of sleep in respiratory diseases. Physicians treating these patients tended to focus mainly on the daily disabling symptoms, overlooking the possible significant role of coexisting sleep disorders such as obstructive sleep apnoea (OSA). Nowadays, OSA has been recognised as an important, highly prevalent comorbidity for respiratory diseases such as COPD, asthma and interstitial lung diseases (ILDs). Overlap syndrome refers to the coexistence of chronic respiratory disease and OSA in the same patient. Although, in the past, overlap syndromes have been poorly studied, recent data underline that they result in increased morbidity and mortality compared with either underlying disorder alone. OSA and respiratory disease may be of different severity, and this, along with the existence of various clinical phenotypes, points to the necessity of an individualised therapeutic plan. Early recognition and OSA management could offer key benefits, such as improved sleep, quality of life and disease outcomes. Educational aims Describe pathophysiological aspects of OSA in chronic respiratory diseases such as COPD, asthma and ILDs.Understand the bidirectional clinical importance when OSA coexists in chronic respiratory diseases.Review current knowledge of treatment strategies towards an individualised therapeutic plan resulting in patient-centric outcomes.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Michail Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece,Corresponding author: Sophia Schiza ()
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