Sleep and cardiometabolic comorbidities in the obstructive sleep apnoea-COPD overlap syndrome: data from the European Sleep Apnoea Database

Mafalda van Zeller; Ozen K Basoglu; Johan Verbraecken; Carolina Lombardi; Walter T McNicholas; Jean-Louis Pepin; Paschalis Steiropoulos; Pawel Sliwinski; Daniela Correia; Maria R Bonsignore; Sophia E Schiza; Jan Hedner; Ludger Grote; Marta Drummond; European Sleep Apnoea Database study group; European Sleep Apnoea Database study group

doi:10.1183/23120541.00676-2022

Sleep and cardiometabolic comorbidities in the obstructive sleep apnoea-COPD overlap syndrome: data from the European Sleep Apnoea Database

ERJ Open Res. 2023 Jun 26;9(3):00676-2022. doi: 10.1183/23120541.00676-2022. eCollection 2023 May.

Authors

Mafalda van Zeller¹, Ozen K Basoglu², Johan Verbraecken³, Carolina Lombardi⁴, Walter T McNicholas⁵, Jean-Louis Pepin⁶, Paschalis Steiropoulos⁷, Pawel Sliwinski⁸, Daniela Correia⁹, Maria R Bonsignore^{10

11}, Sophia E Schiza¹², Jan Hedner¹³, Ludger Grote¹³, Marta Drummond¹; European Sleep Apnoea Database study group; European Sleep Apnoea Database study group

Affiliations

¹ Sleep and Ventilation Unit, Centro Hospitalar Universitário de São João and Faculty of Medicine, University of Porto, Porto, Portugal.
² Ege University, Department of Chest Diseases, Izmir, Turkey.
³ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
⁴ Sleep Disorder Center, Cardiology Department, Istituto Auxologico Italiano IRCCS, Ospedale San Luca and University of Milano Bicocca, Milan, Italy.
⁵ Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, and School of Medicine, University College Dublin, Dublin, Ireland.
⁶ Université Grenoble Alpes, INSERM U1300, CHU de Grenoble, Grenoble, France.
⁷ Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece.
⁸ Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
⁹ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional and Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
¹⁰ CNR, Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy.
¹¹ Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo, Palermo, Italy.
¹² Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece.
¹³ Department of Sleep Medicine, Sahlgrenska University Hospital, and the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

Abstract

Aim: The impact of obstructive sleep apnoea (OSA)-COPD overlap syndrome (OVS) on sleep quality and cardiovascular outcomes has not been fully explored. We aimed to compare clinical and polysomnographic characteristics of patients with OVS versus patients with OSA, and to explore pathophysiological links between OVS and comorbidities.

Study design and methods: This cross-sectional analysis initially included data from 5600 patients with OSA and lung function in the European Sleep Apnoea Database. Two subgroups of patients with OSA (n=1018) or OVS (n=509) were matched (2:1) based on sex, age, body mass index and apnoea-hypopnea index at baseline.

Results: After matching, patients with OVS had more severe hypoxia, lower sleep efficiency and presented with higher prevalences of arterial hypertension, ischaemic heart disease and heart failure compared with patients with OSA. OVS was associated with a significant decrease in sleep efficiency (mean difference (β) -3.0%, 95% CI -4.7 to -1.3) and in nocturnal mean peripheral oxyhaemoglobin saturation (S_pO₂) (β -1.1%, 95% CI -1.5 to -0.7). Further analysis revealed that a decrease in forced expiratory volume in 1 s and arterial oxygen tension was related to a decrease in sleep efficiency and in mean nocturnal S_pO₂. A COPD diagnosis increased the odds of having heart failure by 1.75 (95% CI 1.15-2.67) and systemic hypertension by 1.36 (95% CI 1.07-1.73). Nocturnal hypoxia was strongly associated with comorbidities; the mean nocturnal S_pO₂ and T90 (increase in time below S_pO₂ of 90%) were associated with increased odds of systemic hypertension, diabetes and heart failure but the oxygen desaturation index was only related to hypertension and diabetes.

Conclusion: Patients with OVS presented with more sleep-related hypoxia, a reduced sleep quality and a higher risk for heart failure and hypertension.