COPD-OSA Overlap Syndrome: Evolving Evidence Regarding Epidemiology, Clinical Consequences, and Management

COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.

https://err.ersjournals.com/content/errev/28/153/190064.full.pdf

Sleep in chronic respiratory disease: COPD and hypoventilation disorders.

Rationale: The combined impact of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) on cardiovascular outcomes remains controversial.Objectives: We determined whether t...

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201802-136OC

Cardiovascular Outcomes and All-Cause Mortality in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease (Overlap Syndrome).

The combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is associated with substantial morbidity and mortality We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population Therefore, we investigated associations between traditional OSA risk factors (eg age), and sleep questionnaires [eg Epworth Sleepiness Scale] in 44 patients with advanced COPD As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events (eg atrial fibrillation), and sleep questionnaires [eg Pittsburgh Sleep Quality Index (PSQI)] For the pilot questionnaire, a BMI ≥25 kg/m2 and the presence of cardiovascular disease were used to construct the pilot screening test Male: 59%; OSA 66% FEV1 (mean ± SD) = 410±182% pred, FEV1/FVC = 415±127%] Male gender, older age, and large neck circumference were not associated with OSA Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression In contrast, BMI ≥25 kg/m2 (OR = 394, p = 004) and diagnosis of cardiovascular disease (OR = 506, p = 003) were significantly associated with OSA [area under curve (AUC) = 074] The pilot COPD-OSA test (OR = 528, p = 005) and STOP-Bang questionnaire (OR = 513, p = 003) were both associated with OSA in Receiver Operating Characteristics (ROC) analysis The COPD-OSA test had the best AUC (074), sensitivity (92%), and specificity (83%) A ten-fold cross-validation validated our results We found that traditional OSA predictors (eg gender, Epworth score) did not perform well in patients with more advanced COPD Our pilot test may be an easy to implement instrument to screen for OSA However, a larger validation study is necessary before further clinical implementation is warranted

/pdf/age-gender-neck-circumference-and-epworth-sleepiness-scale-2t72vojvrh.pdf

Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): The challenge to predict OSA in advanced COPD.

The chronic obstructive pulmonary disease exacerbation.

Rationale: The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated.Objectives: To evaluate the importance of lung inflation on OSA severity (apnea–hypopnea index [AHI]) in smokers with suspected OSA.Methods: Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m2) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping.Measurements and Main Results: For the group overall, there was evidence of obstructiv...

/pdf/effect-of-emphysema-severity-on-the-apnea-hypopnea-index-in-15f6wdb40e.pdf

Effect of Emphysema Severity on the Apnea–Hypopnea Index in Smokers with Obstructive Sleep Apnea

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function tests (PFT) after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas transfer at short term follow-up. METHODS: We retrospectively studied subjects who were hospitalized for COVID-19 pneumonia and discharged. Serum inflammatory biomarkers, CT scan and clinical characteristics were assessed. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross sectional area were analyzed. Also the amount of opacification on CT (ground glass opacities). PFT were performed 2-3 months after discharge. The diffusion capacity of carbon monoxide (DLCO) was obtained. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO ≥80% predicted (Normal DLCO). RESULTS: 38 subjects were included in our cohort. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. The groups were similar in terms of demographics, body mass index, comorbidities, and smoking status. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r = -0.343, p = 0.035). CONCLUSIONS: Abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO at follow-up. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. Pulmonary vascular abnormalities during hospitalization for COVID-19 may serve as a biomarker for abnormal gas transfer after COVID-19 pneumonia.

/pdf/association-of-abnormal-pulmonary-vasculature-on-ct-scan-for-342sd3ckwg.pdf

Association of abnormal pulmonary vasculature on CT scan for COVID-19 infection with decreased diffusion capacity in follow up: A retrospective cohort study.

0631 effect of disease severity on determining body position during sleep in patients with positional obstructive sleep apnea

http://www.cecity.com/aoa/healthwatch/2015/april_2015/print2.pdf

What is chronic obstructive pulmonary disease

We describe a case of successful use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO), as a bridge to cytoreductive therapy, in a patient with large mediastinal mass due to T cell lymphoblastic leukemia, complicated by acute cardiorespiratory compromise from mechanical compression and pulmonary embolism.

/pdf/veno-arterial-extracorporeal-membrane-oxygenationas-a-bridge-4k6iwwqwgu.pdf

Veno-arterial extracorporeal membrane oxygenationas a bridge to cytolytic therapy.

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