Sleep-disordered Breathing in Patients with Chronic Obstructive Pulmonary Disease: Prevalence and Outcomes

Marin, Jose M. (Universidad de Zaragoza) ; Soriano, Joan B. ; Marin-Oto, Marta (Universidad de Zaragoza) ; De-Torres, Juan P. ; Seijo, Luis M. ; Cabrera, Carlos ; Solanes, Ingrid ; Martinez, Cristina ; Toledo-Pons, Nuria ; Feu, Nuria ; Amado, Carlos ; Vigil, Laura ; Celli, Bartolome R. ; Casanova, Ciro

Resumen: Rationale: The prevalence of obstructive sleep apnea (OSA) or nocturnal hypoxemia without OSA (i.e., isolated nocturnal hypoxemia [iNH]) and its impact on the natural history of chronic obstructive pulmonary disease (COPD) are unclear.

Objective: We determined the prevalences of OSA and iNH in patients with COPD and their contribution to all-cause mortality and COPD exacerbations.

Methods: At baseline, we performed home sleep apnea testing in the CHAIN (COPD History Assessment in Spain) study cohort. OSA was defined by an apnea–hypopnea index of ⩾15 events per hour, and iNH was defined by an oxygen saturation as measured by pulse oximetry <90% for >30% of the nocturnal recording time. During an observation time of 6.5 years, we evaluated the association of OSA or iNH with all-cause mortality using multivariable Cox regression models and with COPD exacerbations using negative binomial models.

Results: Among 428 patients with COPD, OSA and nocturnal hypoxemia were ruled out in 41%, whereas 27% had iNH and 32% had OSA (i.e., COPD/OSA “overlap syndrome” [OVS]). OVS was independently associated with obesity as defined by a body mass index ⩾30 kg/m2 and with severe COPD exacerbations (P < 0.01), whereas iNH was associated with lower forced expiratory volume in 1 second and lower resting arterial oxygen saturation. Compared with patients with COPD without OSA or iNH, those with untreated OVS had greater risks of mortality (hazard ratio, 1.74; 95% confidence interval, 1.03–2.94) and COPD exacerbations (incidence rate ratio, 1.44; 95% confidence interval, 1.05–2.03).

Conclusions: OSA and iNH are frequent in patients with COPD, and the prevalences decrease or increase, respectively, with disease severity. Patients with COPD with untreated OVS but not with iNH had a greater risk of all-cause mortality and COPD exacerbations.

Idioma: Inglés

DOI: 10.1513/AnnalsATS.202501-030OC

Año: 2025

Publicado en: Annals of the American Thoracic Society 22, 8 (2025), 1227-1235
ISSN: 2329-6933

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)