Association Between Chronic Obstructive Pulmonary Disease and Sleep Apnea - Overlap Syndrome- Experience of Pulmonology Clinic Tg. Mures, Romania

Abstract

Association between chronic obstructive pulmonary disease (COPD) and sleep apnea SA (overlap syndrome - OS) includes serious clinical manifestations and high mortality due to early respiratory failure, cardiovascular and metabolic complications from both diseases. 90 COPD patients (85.5% males) were strongly suspected to have concomitant SA after clinical examination and sleep questionnaires. We performed a cardio-ventilatory poligraphy during sleep. 82 patients (91.1%) from our OS group had obstructive sleep apnea (OSA), 8 patients (8.9%) mixed apnea and 20% had also OHS. 17 (18.8%) of OS were overweight and 66 (73.3%) obese. A third of them were in a very active group of age: 49 patients (54.4%) under 60 year-old and 11 patients (12.2%) between 61-65 year/old. We noted severe complication/comorbidities in our OS group: 63.3% hypertension, 43.3% core pulmonale, 31.1% arrhythmia, 32.2% cardiac failure, 38.8% dyslipidemia, 31.1% diabetes. The second night investigation permitted titration for the targeted pressures for CPAP therapy (Continuous Positive Airways Pressure). Treatment of OS patients had an interdisciplinary approach: CPAP in OSA, BPAP (Bi-level Positive Airways Pressure) in OHS, inhaled bronchodilators, treatment of cardiovascular comorbities, pulmonary rehabilitation, weight loss, tobacco/alcohol cessation counseling, and oxygen therapy in remaining hypoxemic patients. 51.2% of patients had not accessibility for long time CPAP (lack of coverage by the public health system). OS included clinical aspects of severity due to both COPD and OSA. Clinical investigation, sleep questionnaires, assessment of the diurnal somnolence and sleep cardiorespiratory poligraphy are recommended in all COPD patients. Obesity was the main risk factor for OSA in COPD patients.