The Prevalence And Clinical Characteristics Of Chronic Obstructive Pulmonary Disease-obstructive Sleep Apnea Overlap Syndrome

Objective and BackgroundChronic obstructive pulmonary disease?COPD?and obstructive sleep apnea?OSA?are common diseases,and the coexistence of COPD and OSA is called overlap syndrome?OVS?.There are few studies on overlap syndrome,and the common limitations are small sample size and diagnostic methods.So,we designed this project to observe the prevalence of overlap syndrome.The clinical characteristics of overlap syndrome were observed by comparing with COPD or OSA alone.According to the severity of COPD and OSA,the clinical characteristics were observed in different subgroups of overlap syndrome.Methods1.This study included the patients referred to Tianjin medical university general hospital respiratory department for suspected COPD or OSA between January 2016 to June 2018,and the patients were diagnosed by pulmonary function test and polysomnography.The cohort was divided into three groups:COPD group,OSA group,and OVS group.2.The prevalence of overlap syndrome was observed.3.General characteristics,polysomnography,pulmonary function test,daytime blood gas analysis,echocardiography,blood routine,blood coagulation,liver and kidney function,lipids and comorbidities were recorded.4.The clinical characteristics of COPD group,OSA group and OVS group were compared.5.According to the severity of COPD and OSA,the OVS patients can be divided into several subgroups.General characteristics,polysomnography,pulmonary function test,daytime blood gas analysis,echocardiography and comorbidities were recorded.The clinical characteristics of OVS subgroups were compared.6.The concentrations of IL-6,IL-8,IL-13,TNF?and CAV-1 were measured by ELISA.The correlations between IL-6,IL-8,IL-13,TNF?,CAV-1 and comorbidities were analyzed.ResultsSection 11.The prevalence of OVS was 17.16%in COPD and 8.34%in OSA.2.OVS was older than OSA and younger than COPD.BMI in OVS was lower than that in OSA and higher than that in COPD.Daytime sleepiness in OVS was lower than that in OSA and higher than that in COPD.The apnea hypopnea index of OVS was lower than that of OSA and higher than that of COPD.The mean and minimum oxygen saturation of OVS at night was lower than those of COPD.The proportion of light sleep in OVS was higher than that in OSA,while the proportion of deep sleep was lower than that in OSA.The daytime PO₂ in OVS was lower than that in OSA,and PCO₂ was higher than that in OSA and COPD.The right ventricular diameter and pulmonary artery pressure of OVS were higher than those of OSA and COPD.The incidence of comorbidities in OVS was higher than that in OSA and COPD.Section 21.In OVS subgroups,age was increased with the degree of COPD and OSA.Daytime sleepiness and BMI were increased with the degree of OSA.The mean and minimum oxygen saturation was decreased with the degree of COPD and OSA.Daytime PO₂was decreased with the degree of COPD.The right ventricular diameter and pulmonary artery pressure were increased with the degree of COPD and OSA.The incidence of comorbidities in OVS subgroups was different.2.The concentrations of IL-6,IL-8,TNF?and CAV-1 were higher in OVS than in OSA and COPD.The concentrations of IL-6,IL-8 and TNF?in OVS with comorbidities were higher than in those without comorbidities,and the concentration of CAV-1 was associated with pulmonary artery pressure.Conclusion1.The prevalence of OVS is high in both COPD and OSA,especially in COPD.2.OVS was older than OSA and younger than COPD.The incidence of OVS among men was higher.BMI and daytime sleepiness in OVS were higher.AHI in OVS was higher than that in COPD and lower than that in OSA and the respiratory events were mainly hypopnea.Nocturnal hypoxemia and the sleep disorders were more serious.Hypercapnia in daytime was more obvious.Right heart function was impaired and pulmonary artery pressure was increased.The incidence of vascular disease comorbidities was high.The utilization of non-invasive ventilator was high.3.The clinical characteristics were different in OVS subgroups with different severity.As the severity of COPD and OSA increased,the nocturnal oxygen saturation of OVS gradually decreased,the sleep disorders were more serious,the right heart diameter and the pulmonary artery pressure increased.The incidence of comorbidities was different in OVS subgroups with different severity.4.The concentrations of IL-6,IL-8,TNF?and CAV-1 were higher in OVS than in COPD and OSA alone.In the patients of OVS with comorbidities,the concentrations of IL-6,IL-8 and TNF?were higher.CAV-1 was associated with pulmonary artery pressure.