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Shen H, Xu Y, Zhang Y, Ren L, Chen R. Efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and obstructive sleep apnea; a randomized controlled trial. J Rehabil Med 2024; 56:jrm23757. [PMID: 39318173 PMCID: PMC11439968 DOI: 10.2340/jrm.v56.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of pulmonary rehabilitation in the outcomes of patients with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome patients who used positive airway pressure. DESIGN Prospective randomized controlled single- blind trial. PATIENTS A total of 79 patients with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome were randomly assigned to either the intervention group (n = 40) or control group (n = 39). METHODS All patients consistently adhered to positive airway pressure therapy every night from enrolment in the study, while intervention group patients received additional moderate-intensity aerobic exercise for 20 weeks. Pre- and post-intervention measurements included the 6-Minute Walk Test, Barthel Index, body mass index, fat mass, free fat mass, forced expiratory volume in 1 s (FEV1), FEV1%predicted, modified Medical Research Council, and polysomnography parameters. RESULTS After 20 weeks, the intervention group exhibited statistically significant improvements in 6MWD, Barthel Index, body mass index, fat mass, and modified Medical Research Council compared with control group (all p < 0.01). In addition, the intervention group showed a significantly lower percentage of total sleep time with oxygen saturation < 90% (p = 0.013) and higher lowest nocturnal oxygen saturation (p = 0.008) than the control group. However, there was no significant difference in FEV1 %predicted between the 2 groups. CONCLUSION Pulmonary rehabilitation incorporating moderate-intensity aerobic exercise could improve physical endurance and motor abilities in individuals with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome, while also improving anamnestic dyspnoea, body composition, and sleep-disordered breathing.
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Affiliation(s)
- Honghua Shen
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China; Department of Respiratory and Critical Care Medicine, Sleep Center, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Xu
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yin Zhang
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Lei Ren
- Department of Respiratory Rehabilitation, the Fourth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Rui Chen
- Department of Respiratory and Critical Care Medicine, Sleep Center, the Second Affiliated Hospital of Soochow University, Suzhou, China.
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Nguyen BHM, Murphy PB, Yee BJ. Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome: An Update on the Epidemiology, Pathophysiology, and Management. Sleep Med Clin 2024; 19:405-417. [PMID: 39095139 DOI: 10.1016/j.jsmc.2024.04.003] [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: 08/04/2024]
Abstract
This review provides an up-to-date summary of the prevalence, pathophysiology, diagnosis, and treatment of the chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) overlap syndrome (OVS). The presence of OVS is high in patients with COPD and in patients with OSA and is associated with profound nocturnal oxygen desaturation and systemic inflammation. There is a high prevalence of cardiovascular disease among patients with OVS and this likely contributes to increased mortality. Observational studies suggest that positive airway pressure therapy improves survival and reduces COPD exacerbations; however, randomized controlled trials will be required to confirm these findings.
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Affiliation(s)
- Benjamin H M Nguyen
- Department of Thoracic Medicine, Level 4 Xavier Building, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11 Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health, Sydney Medical School, Sydney Medical School Central Sydney, The University of Sydney, NSW 2006, Australia; The Woolcock Institute of Medical Research, Macquarie University, 2 Innovation Road, Macquarie Park, NSW 2113, Australia.
| | - Patrick B Murphy
- Lane Fox Respiratory Service, Division of Heart, Lung and Critical Care, Guy's & St Thomas NHS Foundation Trust, Ground Floor, South Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH; King's College London, Strand, London WC2R 2LS, United Kingdon
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11 Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; The Woolcock Institute of Medical Research, Macquarie University, 2 Innovation Road, Macquarie Park, NSW 2113, Australia
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Macrea M, Malhotra A, ZuWallack R, Oursler K, Casaburi R. A Cross-Sectional Study Evaluating the Association of Brachial Artery Flow Mediated Vasodilation with Physical Activity Measured by Accelerometry in Patients with the Overlap of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:773-778. [PMID: 38524399 PMCID: PMC10960536 DOI: 10.2147/copd.s432243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Overlap Syndrome (OS), the co-occurrence of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Clustering of patients in subgroups with similar pre-clinical manifestations (ie, endothelial dysfunction) may identify relevant therapeutic phenotype categories for patients with OS who are at high risk of CVD. We therefore conducted a cross-sectional pilot study of endothelial function in 7 patients with OS (Forced Expiratory Volume in 1 second/Forced Vital Capacity < 0.7) on continuous positive airway pressure therapy (n = 7) to assess the relationship between FMD and physical activity. We found a strong association between FMD and step counts (rho = 0.77, p = 0.04); and FMD and moderate physical activity (rho = 0.9, p = 0.005). Further, larger studies are needed to confirm that FMD may identify patients with OS at high risk of CVD who benefit from increased physical activity.
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Affiliation(s)
- Madalina Macrea
- Department of Pulmonary and Sleep Medicine, Salem Veterans Affairs Medical Center, University of Virginia, Charlottesville, VA, USA
| | - Atul Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California at San Diego, San Diego, CA, USA
| | - Richard ZuWallack
- Department of Pulmonary, Critical Care, and Sleep Medicine St. Francis Hospital, Hartford, CT, USA
| | - Krisann Oursler
- Department of Geriatrics and Infection Disease, Salem Veterans Affairs Medical Center, Carilion Virginia Tech School of Medicine, Roanoke, VA, USA
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles Medical Center, Torrance, CA, USA
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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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Esteban C, Antón-Ladislao A, Aramburu A, Chasco L, Orive M, Sobradillo P, López-Roldan L, Jiménez-Puente A, de Miguel J, García-Talavera I, Quintana JM. Physical activity and sedentary behaviour in patients admitted with COPD: Associated factors. Respir Med Res 2023; 84:101052. [PMID: 37897880 DOI: 10.1016/j.resmer.2023.101052] [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: 12/30/2022] [Revised: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
AIM To establish amongst a cohort of patients admitted with Chronic Obstructive Pulmonary Disease which factors were associated with their level of Physical Activity and Sedentary Behavior prior to the admission event. METHODS Prospective observational cohort study. Nine Spanish hospitals participated. Patients were recruited consecutively. Variables relating to the patients' clinical baseline status were recorded, including the COPD Assessment test, the HADS anxiety-depression test, comorbidities and the Yale Physical Activity Survey. Data relating to admission and up to two months after discharge were also recorded. RESULTS 1638 COPD patients were studied, with a mean age of 72.39 (SD 10.33), 76.56 % male, FEV1 49.41 % (SD19.19), Charlson index 2. The level of PA at baseline was 30.79 points (SD 22.43). Multivariable linear regression analysis identified the following as being associated with low PA: older age, obesity, higher level of hemoglobin, lower score of Barthel index, which means disability, health related quality of life (EuroQoL-5d and CAT) and dyspnea. Variables associated with sedentary behavior were: older age, presence of obstructive apnea syndrome, higher disability, presence of depressive symptoms and dyspnea. CONCLUSIONS In a cohort of hospitalized COPD patients, we have found several variables, some of them modifiable, associated with physical activity/inactivity and sedentary behavior.
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Affiliation(s)
- Cristóbal Esteban
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain.
| | - Ane Antón-Ladislao
- Research Unit, Hospital Galdakao, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Amaia Aramburu
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Leyre Chasco
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Miren Orive
- Departamento Psicología Social, Facultad Farmacia, UPV/EHU, Vitoria-Gasteiz, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Patricia Sobradillo
- Servicio de Respiratorio, Hospital Cruces, Barakaldo, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | | | - Alberto Jiménez-Puente
- Unidad de Evaluación, Hospital Costa del Sol, Marbella, Malaga, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Javier de Miguel
- Servicio de Respiratorio, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)., Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Ignacio García-Talavera
- Servicio de Respiratorio, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - José M Quintana
- Research Unit, Hospital Galdakao, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Kronikgune Research Institute, Barakaldo, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
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Czerwaty K, Dżaman K, Sobczyk KM, Sikorska KI. The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review. Biomedicines 2022; 11:biomedicines11010016. [PMID: 36672523 PMCID: PMC9856172 DOI: 10.3390/biomedicines11010016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases that strongly impact the quality and length of life. Their coexistence is determined by overlap syndrome (OS). This systematic review aims to define the significance of these comorbidities according to the current state of knowledge. For this systematic review, we searched PubMed, Scopus, and Cochrane for studies published between 2018 and 26 October 2022, to find original, observational, human studies published in English, where the diagnosis of COPD was according to the Global Initiative for Obstructive Lung Disease guidelines and the diagnosis of OSA was based on polysomnography. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool for cohort and case-control studies, as well as its modification for cross-sectional studies. Of the 1548 records identified, 38 were eligible and included in this systematic review. The included studies covered a total population of 27,064 participants. This paper summarizes the most important, up-to-date information regarding OS, including the prevalence, meaning of age/gender/body mass index, polysomnography findings, pulmonary function, comorbidities, predicting OSA among COPD patients, and treatment of this syndrome.
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Pola DCD, Hirata RP, Schneider LP, Bertoche MP, Furlanetto KC, Mesas AE, Pitta F. Sleep-onset time variability and sleep characteristics on weekday and weekend nights in patients with COPD. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210412. [PMID: 36074407 PMCID: PMC9496202 DOI: 10.36416/1806-3756/e20210412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate sleep-onset time variability, as well as sleep characteristics on weekday and weekend nights, in individuals with moderate-to-severe COPD. Methods: Sleep was objectively assessed by an activity/sleep monitor for seven consecutive nights in individuals with COPD. For analysis, individuals were divided into two groups according to sleep-onset time variability results, characterized by intrasubject standard deviation of sleep-onset time (SOTV) ≥ 60 min or < 60 min. Results: The sample comprised 55 individuals (28 males; mean age = 66 ± 8 years; and median FEV1 % of predicted = 55 [38-62]). When compared with the SOTV<60min group (n = 24), the SOTV≥60min group (n = 31) presented shorter total sleep time (5.1 ± 1.3 h vs. 6.0 ± 1.3 h; p = 0.006), lower sleep efficiency (73 ± 12% vs. 65 ± 13%; p = 0.030), longer wake time after sleep onset (155 ± 66 min vs. 115 ± 52 min; p = 0.023), longer duration of wake bouts (19 [16-28] min vs. 16 [13-22] min; p = 0.025), and higher number of steps at night (143 [104-213] vs. 80 [59-135]; p = 0.002). In general, sleep characteristics were poor regardless of the day of the week, the only significant difference being that the participants woke up about 30 min later on weekends than on weekdays (p = 0.013). Conclusions: Sleep-onset time varied over 1 h in a standard week in the majority of individuals with COPD in this sample, and a more irregular sleep onset indicated poor sleep quality both on weekdays and weekends. Sleep hygiene guidance could benefit these individuals if it is integrated with their health care.
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Affiliation(s)
- Daniele Caroline Dala Pola
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Raquel Pastrello Hirata
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Lorena Paltanin Schneider
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Mariana Pereira Bertoche
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Karina Couto Furlanetto
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil.,. Centro de Pesquisa em Ciências da Saúde, Universidade Pitágoras-Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil
| | - Arthur Eumann Mesas
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil.,. Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Fabio Pitta
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
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Lurie A, Roche N. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: Facts and Perspectives. COPD 2021; 18:700-712. [PMID: 34595967 DOI: 10.1080/15412555.2021.1950663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in the same patient, named the overlap syndrome (OS), was first described in 1985. Although the American Thoracic Society underlined the limited knowledge of OS, stated research priorities for this condition, and recommended a "screening" strategy to identify OSA in COPD patients with chronic stable hypercapnia, research studies on OS remain scarce. This review aims to summarize the current knowledge and perspectives related to OSA in COPD patients. OS prevalence is 1.0-3.6% in the general population, 3-66% in COPD patients, and 7-55% in OSA patients. OS patients may have worse sleep quality than those with OSA or COPD alone. Scoring hypopneas may be difficult in COPD patients; desaturation episodes may have origins in these patients, namely upper airway obstruction, hypoventilation during paradoxical sleep, ventilation/perfusion mismatches, and obesity. The apnea-hypopnea index is similar in OSA and OS patients. Desaturations may be greater and more prolonged in OS patients than in patients with COPD or OSA alone. Low body mass index, hyperinflation, and less collapsible airways reduce the risk of OSA in COPD patients. OSA is a risk factor for pulmonary hypertension in COPD patients. Whether OS increases mortality and morbidity risks compared to COPD or OSA alone remains to be confirmed. No guidelines currently recommend specific approaches to the treatment of OSA in patients with COPD.
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Affiliation(s)
- Alain Lurie
- Clinique Ambroise Paré, Laboratoire du sommeil, Neuilly-sur-Seine, France.,Hôpital Cochin (AP-HP Centre), Pneumologie, Paris, France
| | - Nicolas Roche
- Hôpital Cochin (AP-HP Centre), Pneumologie, Université de Paris (Descartes), UMR 1016, Institut Cochin, Paris, France
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Ambati A, Ju YE, Lin L, Olesen AN, Koch H, Hedou JJ, Leary EB, Sempere VP, Mignot E, Taheri S. Proteomic biomarkers of sleep apnea. Sleep 2021; 43:5830732. [PMID: 32369590 DOI: 10.1093/sleep/zsaa086] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/09/2020] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is characterized by recurrent partial to complete upper airway obstructions during sleep, leading to repetitive arousals and oxygen desaturations. Although many OSA biomarkers have been reported individually, only a small subset have been validated through both cross-sectional and intervention studies. We sought to profile serum protein biomarkers in OSA in unbiased high throughput assay. METHODS A highly multiplexed aptamer array (SomaScan) was used to profile 1300 proteins in serum samples from 713 individuals in the Stanford Sleep Cohort, a patient-based registry. Outcome measures derived from overnight polysomnography included Obstructive Apnea Hypopnea Index (OAHI), Central Apnea Index (CAI), 2% Oxygen Desaturation index, mean and minimum oxygen saturation indices during sleep. Additionally, a separate intervention-based cohort of 16 individuals was used to assess proteomic profiles pre- and post-intervention with positive airway pressure. RESULTS OAHI was associated with 65 proteins, predominantly pathways of complement, coagulation, cytokine signaling, and hemostasis which were upregulated. CAI was associated with two proteins including Roundabout homolog 3 (ROBO3), a protein involved in bilateral synchronization of the pre-Bötzinger complex and cystatin F. Analysis of pre- and post intervention samples revealed IGFBP-3 protein to be increased while LEAP1 (Hepicidin) to be decreased with intervention. An OAHI machine learning classifier (OAHI >=15 vs OAHI<15) trained on SomaScan protein measures alone performed robustly, achieving 76% accuracy in a validation dataset. CONCLUSIONS Multiplex protein assays offer diagnostic potential and provide new insights into the biological basis of sleep disordered breathing.
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Affiliation(s)
- Aditya Ambati
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Yo-El Ju
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Ling Lin
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Alexander N Olesen
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Henriette Koch
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Julien Jacques Hedou
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Eileen B Leary
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Vicente Peris Sempere
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
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11
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D'Cruz RF, Murphy PB, Kaltsakas G. Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes. J Thorac Dis 2020; 12:S202-S216. [PMID: 33214924 PMCID: PMC7642631 DOI: 10.21037/jtd-cus-2020-006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) causes load-capacity-drive imbalance in both wakefulness and sleep, principally driven by expiratory flow limitation and hyperinflation. Sleep imposes additional burdens to the respiratory muscle pump, driven by changes in respiratory muscle tone, neural respiratory drive and consequences of the supine position. COPD patients are therefore at higher risk of decompensation during sleep, which may manifest as altered sleep architecture, isolated nocturnal desaturation, sleep hypoventilation and restless legs. Each form of sleep disordered breathing in COPD is associated with adverse clinical and patient-reported outcomes, including increased risk of exacerbations, hospitalisation, cardiovascular events, reduced survival and poorer quality of life. COPD-obstructive sleep apnoea (OSA) overlap syndrome represents a distinct clinical diagnosis, in which clinical outcomes are significantly worse than in either disease alone, including increased mortality, risk of cardiovascular events, hospitalisation and exacerbation frequency. Sleep disordered breathing is under-recognised by COPD patients and their clinicians, however early diagnosis and management is crucial to reduce the risk of adverse clinical outcomes. In this narrative review, we describe the pathophysiology of COPD and physiological changes that occur during sleep, manifestations and diagnosis of sleep disordered breathing in COPD and associated clinical outcomes.
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Affiliation(s)
- Rebecca F D'Cruz
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Centre for Human & Applied Physiological Sciences, King's College London, UK
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12
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Relationships Among and Predictive Values of Obesity, Inflammation Markers, and Disease Severity in Pediatric Patients with Obstructive Sleep Apnea Before and After Adenotonsillectomy. J Clin Med 2020; 9:jcm9020579. [PMID: 32093397 PMCID: PMC7073666 DOI: 10.3390/jcm9020579] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Both obstructive sleep apnea (OSA) and obesity are major health issues that contribute to increased systemic inflammation in children. To date, adenotonsillectomy (AT) is still the first-line treatment for childhood OSA. However, the relationships among and predictive values of obesity, inflammation, and OSA severity have not been comprehensively investigated. This prospective study investigated body mass index (BMI), serum inflammatory markers, and OSA severity before and after AT in 60 pediatric patients with OSA. At baseline, differences in levels of interleukin-6, interleukin-9, basic fibroblast growth factor, platelet-derived growth factor-BB, as well as regulated on activation, normal T cell expressed and secreted (RANTES) were significant among the various weight status and OSA severity subgroups. After 3 months postoperatively, the differences in these inflammatory markers diminished along with a decrease in OSA severity while obesity persisted. The rate of surgical cure (defined as postoperative obstructive apnea-hypopnea index < 2.0 and obstructive apnea index < 1.0) was 62%. Multivariate analysis revealed that age, BMI z-score, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1, and RANTES independently predicted surgical cure. Despite the significant reductions in inflammatory markers and OSA severity after AT, an inter-dependent relationship between obesity and OSA persisted. In addition to age and BMI, several inflammatory markers helped to precisely predict surgical cure.
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