Clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in OSAHS patients combined with COPD_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Yanhua ,  YUAN Kaifen , CAO Lijiao , YIN Fenying , MA Jianfang , HUANG Xiaoling

Department of General Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650051, P. R. China;

Corresponding author：

YUAN Kaifen, Email: Kaifenyuan@hotmail.com

Keywords：

Obstructive sleep apnea hypopnea syndrome; chronic obstructive pulmonary disease; inflammatory factors; cardiopulmonary function; Hypoxia

DOI：

10.7507/1671-6205.202204014

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Objective To investigate the clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in obstructive sleep apnea hypopnea syndrome (OSAHS) patients combined chronic obstructive pulmonary disease (COPD). Methods A retrospective case-control study was conducted on 209 patients with OSAHS admitted from October 2015 to April 2022. The OSAHS patients were divided into an OSAHS-only group, an OSAHS combined with mild COPD group, an OSAHS combined with moderate COPD group, and an OSAHS combined with severe and very severe COPD group based on pulmonary function test. The characteristics of cardiopulmonary function [(pulmonary artery pressure, N terminal pro B type natriuretic peptide (NT-proBNP), forced expiratory volume in the first second to forced vital capacity (FEV₁/FVC), percent predicted value of FEV₁ (FEV₁%pred)], hypoxia indexes [night lowest saturation of pulse oxygen (NL-SpO₂), night medial saturation of pulse oxygen (NM-SpO₂), saturation of pulse oxygen less than 85% of the time (TS85), diurnal lowest saturation of pulse oxygen (DL-SpO₂)], inflammatory factor indicators [procalcitonin (PCT), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR)], and other characteristics were compared separately. The partial correlation analysis and logistic regression were used to analyze the influencing factors of OSAHS with COPD. Results There were statistically significant differences in age, days of hospitalization, cardiopulmonary function indexes, hypoxia indexes and inflammatory factor indexes between the OSAHS combined with COPD group and the OSAHS-only group (all P<0.05). And pulmonary artery pressure, NT-proBNP, TS85, IL-6, and NLR were higher and DL-SpO₂, NL-SpO₂, and NM-SpO₂ were lower in the OSAHS combined with severe and very severe COPD group compared with the OSAHS combined with mild COPD group (all P<0.05). In the partial correlation analysis, FEV₁%pred was negatively correlated with pulmonary artery pressure, NT-proBNP, TS85, IL-6, hs-CRP and NLR, and positively correlated with DL-SpO₂, NL-SpO₂ and NM-SpO₂ (all P<0.05). In regression analysis, NLR and TS85 were the main risk factors for OSAHS combined with COPD (all P<0.05). Conclusions OSAHS patients combined with COPD have longer hospital days, greater burden of hypoxia, cardiopulmonary function and inflammation compared with patients with OSAHS alone, especially more significant in patients with poorer pulmonary function, and higher incidence of pulmonary heart disease, atrial fibrillation, and lower limb edema. NLR and TS85 are the main risk factors in patients with OSAHS combined with severe and very severe COPD.

Citation： LI Yanhua, YUAN Kaifen, CAO Lijiao, YIN Fenying, MA Jianfang, HUANG Xiaoling. Clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in OSAHS patients combined with COPD. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(9): 629-635. doi: 10.7507/1671-6205.202204014 Copy

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12.	Kendzerska T, Leung RS, Aaron SD, et al. Cardiovascular outcomes and all-cause mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease (overlap syndrome). Ann Am Thorac Soc, 2019, 16(1): 71-81.
13.	Spicuzza L, Campisi R, Crimi C, et al. Prevalence and determinants of co-morbidities in patients with obstructive apnea and chronic obstruct ive pulmonary disease. Eur J Intern Med, 2019, 69: e15-e16.
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18.	Voulgaris A, Archontogeorgis K, Steiropoulos P, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, obstructive sleep apnoea syndrome and overlap syndrome. Curr Vasc Pharmacol, 2021, 19(3): 285-300.
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20.	Lacedonia D, Carpagnano GE, Patricelli G, et al. Prevalence of comorbidities in patients with obstructive sleep apnea syndrome, overlap syndrome and obesity hypoventilation syndrome. Clin Respir J, 2018, 12(5): 1905-1911.
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1. 陈贵海, 张立强, 高雪梅, 等. 成人阻塞性睡眠呼吸暂停多学科诊疗指南. 中华医学杂志, 2018, 98(24): 1902-1914.
2. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205.
3. Cao Y, Xing ZZ, Long HY, et al. Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit. Respir Res, 2021, 22(1): 77.
4. Zhu J, Zhao ZL, Nie QR, et al. Effect of lung function on the apnea-hypopnea index in patients with overlap syndrome: a multicenter cross-sectional study. Sleep Breath, 2020, 24(3): 1059-1066.
5. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med, 2019, 7(8): 687-698.
6. Zhang P, Chen B, Lou HQ, et al. Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary dis ease in China. BMC Pulm Med, 2022, 22(1): 16.
7. Rafanan AL, Baquilod RA. Sleep-related breathing complaints in chronic obstructive pulmonary disease. Sleep Med Clin, 2022, 17(1): 99-109.
8. D'Cruz RF, Murphy PB, Kaltsakas G. Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classific ation, pathophysiology and clinical outcomes. J Thorac Dis, 2020, 12(Suppl 2): S202-S216.
9. Ioachimescu OC, Janocko NJ, Ciavatta MM, et al. Obstructive Lung Disease and Obstructive Sleep Apnea (OLDOSA) cohort study: 10-year assessment. J Clin Sleep Med, 2020, 16(2): 267-277.
10. Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail, 2021, 23(3): 352-380.
11. 沈久成, 孙丽, 王婧, 等. 阻塞性睡眠呼吸暂停对慢性阻塞性肺疾病患者心肺功能的影响. 中华医学杂志, 2021, 101(22): 1665-1670.
12. Kendzerska T, Leung RS, Aaron SD, et al. Cardiovascular outcomes and all-cause mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease (overlap syndrome). Ann Am Thorac Soc, 2019, 16(1): 71-81.
13. Spicuzza L, Campisi R, Crimi C, et al. Prevalence and determinants of co-morbidities in patients with obstructive apnea and chronic obstruct ive pulmonary disease. Eur J Intern Med, 2019, 69: e15-e16.
14. McNicholas WT. Does associated chronic obstructive pulmonary disease increase morbidity and mortality in obstructive sleep apnea?. Ann Am Thorac Soc, 2019, 16(1): 50-53.
15. Adler D, Bailly S, Benmerad M, et al. Clinical presentation and comorbidities of obstructive sleep apnea-COPD overlap syndrome. PLoS ONE, 2020, 15(7): e0235331.
16. 熊梦清, 蔡永芳, 胡克. 慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停交互作用的研究现状. 中国呼吸与危重监护杂志, 2018, 17(3): 309-312.
17. Wang YY, Li BH, Li P, et al. Severe obstructive sleep apnea in patients with chronic obstructive pulmonary disease is associated with an increased prevalence of mild cognitive impairment. Sleep Med, 2020, 75: 522-530.
18. Voulgaris A, Archontogeorgis K, Steiropoulos P, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, obstructive sleep apnoea syndrome and overlap syndrome. Curr Vasc Pharmacol, 2021, 19(3): 285-300.
19. Papachatzakis I, Velentza L, Zarogoulidis P, et al. Comorbidities in coexisting chronic obstructive pulmonary disease and obstructive sleep apnea - overlap syndrome. Eur Rev Med Pharmacol Sci, 2018, 22(13): 4325-4331.
20. Lacedonia D, Carpagnano GE, Patricelli G, et al. Prevalence of comorbidities in patients with obstructive sleep apnea syndrome, overlap syndrome and obesity hypoventilation syndrome. Clin Respir J, 2018, 12(5): 1905-1911.
21. Rha MS, Kim CH, Yoon JH, et al. Association between the neutrophil-to-lymphocyte ratio and obstructive sleep apnea: a meta-analysis. Sci Rep, 2020, 10(1): 10862.
22. Li SQ, Sun XW, Zhang L, et al. Impact of insomnia and obstructive sleep apnea on the risk of acute exacerbation of chronic obstructi ve pulmonary disease. Sleep Med Rev, 2021, 58: 101444.
23. Du W, Liu J, Zhou J, et al. Obstructive sleep apnea, COPD, the overlap syndrome, and mortality: results from the 2005-2008 Nation al Health and Nutrition Examination Survey. Int J Chron Obstruct Pulmon Dis, 2018, 13: 665-674.
24. Gómez-Rosero JA, Cáceres-Galvis C, Ascuntar J, et al. Biomarkers as a prognostic factor in COPD exacerbation: a cohort study. COPD, 2021, 18(3): 325-332.
25. Acanfora D, Scicchitano P, Carone M, et al. Relative lymphocyte count as an indicator of 3-year mortality in elderly people with severe COPD. BMC Pulm Med, 2018, 18(1): 116.
26. Fitzgibbons CM, Goldstein RL, Gottlieb DJ, et al. Physical activity in overlap syndrome of COPD and obstructive sleep apnea: relationship with markers of systemic inflammation. J Clin Sleep Med, 2019, 15(7): 973-978.
27. Zhou W, Li CL, Cao J, et al. Metabolic syndrome prevalence in patients with obstructive sleep apnea syndrome and chronic obstructive pulmonary disease: relationship with systemic inflammation. Clin Respir J, 2020, 14(12): 1159-1165.
28. Vanfleteren LE, Beghe B, Andersson A, et al. Multimorbidity in COPD, does sleep matter?. Eur J Intern Med, 2020, 73: 7-15.
29. Orr JE, Schmickl CN, Edwards BA, et al. Pathogenesis of obstructive sleep apnea in individuals with the COPD + OSA overlap syndrome versus OSA alone. Physiol Rep, 2020, 8(3): e14371.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical significance of changes in cardiopulmonary function, degree of hypoxia and inflammatory factors in OSAHS patients combined with COPD

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