The effects of OSA in sleep, physical symptoms, and mood in patients with COPD and ASTHMA

Abstract

Introduction Background: COPD and sleep apnea are common disease and many individuals would be expected to have them in combination. It has been believed that the presence of COPD could predispose to development of OSA, but this was not confirmed by epidemiological studies. More recently, Wincosin Sleep cohort suggests that Asthma may increase the chance of developing sleep apnea. Objectives To investigate if OSA had significant impact on sleep, physical symptoms, and mood in patients with COPD and ASTHMA and if these patients had similar response to treatment with nasal CPAP. Materials and methods We included 85 patients; 34 with COPD&OSA (mean age 68.5 ± 10.1 years, B.M.I 35.3 ± 12.3 kg/m2), 34 with OSA (mean age 56.1 ± 12 years, B.M.I 35.3 ± 6.8 kg/m2) and 17 with OSA&ASTHMA (mean age 62 ± 13.7 years, B.M.I 39.4 ± 6.8 kg/m2). They had PSG, Pulmonary Function tests, answered Beck inventory, Whaler Physical Symptoms, Sleep Assessment Questionnaire (SAQ) and the Epworth Sleepiness Scale (ESS). Age, BMI, gender and baseline AHI were compared for the 3 groups using the Chi-square test for gender and the Kruskal–Wallis test for the others. Mann–Whitney test was used for pair wise comparisons where appropriate, ANCOVA for group comparisons in order to adjust for baseline values and regression analysis for comparison of the questionnaires. Results Median AHI was higher in OSA group as compared to OSA&ASTHMA p = 0.002 and COPD&OSA p = 0.05. Median age was higher in COPD&OSA than in OSA group p = 0.0002. Median BMI was significantly higher for the OSA&AS when compared to COPD&OSA p = 0.03 and borderline higher when compared to OSA p = 0.06. Regression analysis did not find significant differences in the Beck score, WPS, SAQ and ESS between the three groups. The pulmonary function test, comparing COPD&OSA and OSA had significant differences in all parameters except TLC %. COPD had significant lower FEV1 post % and DLCO %. Comparing COPD&OSA and OSA&ASHTMA there was significant different in post FEV1% (p = 0.008). Post FEV1% was significant lower for COPD&OSA. For OSA and OSA&ASHTMA there was a significant difference in post FEV1% (p = 0.003) but not in TLC %, RV % or DLCO %. Conclusion Despite lower AHI, patients with COPD&OSA and OSA&ASTHMA had similar SE, daytime sleepiness, Beck Score, WPS and SAQ to OSA patients, suggesting that OSA has a negative impact patient with Asthma and COPD. There was no difference between the groups in regards to response to treatment with nasal CPAP.