Background: Both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) are common diseases. Some recent studies suggest an increased prevalence of COPD among subjects with OSAS. Objectives: The study objective was to evaluate whether there is an epidemiological relationship between COPD and OSAS in a random population sample. Materials and Methods: The study population, 356 males (53%) and 320 females, mean age 56.6 ± 8.2 years (range 41–72), was selected from a voting list for parliamentary election in Warsaw. The investigation included lung diseases and smoking history with polysomnography and spirometry. Results: OSAS was diagnosed in 76 subjects (11.3%), 59 males (8.8%) and 17 females (2.5%), mean apnea/hypopnea index (AHI) was 25.3 ± 16.1, mean overnight SaO2 92.1 ± 3.3%, minimum SaO2 76.9 ± 9.4%, and SaO2 <90% = 18.9 ± 23.9% of total sleep time. COPD was diagnosed in 72 subjects (10.7%), 39 males and 33 females. Severity of airflow limitation was assessed according to European Respiratory Society (ERS) guidelines: mild in 70%, moderate in 22%, and severe in 8%. In 7 subjects (9.2% of OSAS population, 1% of total population) OSAS and COPD overlapped. Polysomnographic variables were compared between overlap (overlap syndrome, OS) and OSAS subjects. In the OS mean AHI was 19.0 versus 25.3 in OSAS (nonsignificant), mean SaO2 89.6 versus 92.3% in OSAS (p < 0.005), and time spent in SaO2 <90% was 25.4 versus 18.2% in OSAS (p = 0.04). Conclusions: COPD in subjects with OSAS was as frequent as in the general population. In the OS group mean arterial blood saturation was lower and time spent in desaturation was longer than in OSAS. The presented data suggest a more severe course of sleep-disordered breathing in subjects with coexisting COPD.

Keywords:
Chronic obstructive pulmonary disease, Obstructive sleep apnea syndrome
1.
Pena VS, Miravitlles M, Gabriel R, et al: Geographic variations in prevalence and underdiagnosis of COPD: Results of the IBERPOC multicentre epidemiological study. Chest 2000;118:981–989.
2.
Lundback B, Nystrom L, Rosenhall L, Stjernberg N: Obstructive lung disease in northern Sweden: Respiratory symptoms assessed in a postal survey. Eur Respir J 1991;4:257–266.
3.
Viegi G, Pedreschi M, Pistelli F, et al: Prevalence of airways obstruction in a general population: European Respiratory Society vs. American Thoracic Society definition. Chest 2000;117:339S–345S.
4.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235.
5.
Flenley DC: Sleep in chronic obstructive lung disease. Clin Chest Med 1985;6:651–661.
6.
Larsson LG, Lindberg A, Franklin KA, Lundback B: Obstructive sleep apnoea syndrome is common in subjects with chronic bronchitis. Report from the Obstructive Lung Disease in Northern Sweden studies. Respiration 2001;68:250–255.
7.
Guilleminault C, Cummiskey J, Motta J: Chronic obstructive airflow disease and sleep studies. Am Rev Respir Dis 1980;122:397–406.
8.
Chaouat A, Weitzenblum E, Krieger J, Ifoundza T, Oswald M, Kessler R: Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am J Respir Crit Care Med 1995;151:82–86.
9.
Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A: Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994;90:583–612.
10.
Siafakas NM, Vermeire P, Pride NB, et al: Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J 1995;8:1398–1420.
11.
American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med 1995;152:1107–1136.
12.
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993;16:5–40.
13.
Johns MW: A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540–545.
14.
Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667–689.
15.
Rechtschaffen A, Kales A: A manual of standardised terminology, technique and scoring system for sleep stages of human subjects. Washington, NIH, 1968, Publication No 204.
16.
Krzyzanowski M, Jedrychowski W, Wysocki M: Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;134:1011–1019.
17.
Young T, Shahar E, Nieto FJ, et al: Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med 2002;162:893–900.
18.
Sanders MH, Newman AB, Haggerty CL, et al: Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003;167:7–14.
19.
Verse T, Pirsig W, Junge-Hulsing B, Kroker B: Validation of the POLY-MESAM seven-channel ambulatory recording unit. Chest 2000;117:1613–1618.
20.
Marrone O, Salvaggio A, Insalaco G, Bonsignore MR, Bonsignore G: Evaluation of the POLYMESAM system in the diagnosis of obstructive sleep apnea syndrome. Monaldi Arch Chest Dis 2001;56:486–490.
21.
Guilleminault C: Sleep apnea syndromes: Impact of sleep and sleep states. Sleep 1980;3:227–234.
22.
Series F, Roy N, Marc I: Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med 1994;150:481–485.
23.
Espinoza H, Thornton AT, Sharp D, Antic R, McEvoy RD: Sleep fragmentation and ventilatory responsiveness to hypercapnia. Am Rev Respir Dis 1991;144:1121–1124.
24.
Spengler CM, Shea SA: Sleep deprivation per se does not decrease the hypercapnic ventilatory response in humans. Am J Respir Crit Care Med 2000;161:1124–1128.
25.
US Surgeon General: The health consequences of smoking: Chronic obstructive pulmonary disease. Report. 1984, DHHS Publ No 84-50205.
26.
Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M: Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994;154:2219–2224.
27.
Jennum P, Sjol A: Epidemiology of snoring and obstructive sleep apnoea in a Danish population, age 30–60. J Sleep Res 1992;1:240–244.
28.
Gislason T, Benediktsdottir B, Bjornsson JK, Kjartansson G, Kjeld M, Kristbjarnarson H: Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest 1993;103:1147–1151.
29.
Alchanatis M, Tourkohoriti G, Kakouros S, Kosmas E, Podaras S, Jordanoglou JB: Daytime pulmonary hypertension in patients with obstructive sleep apnea: The effect of continuous positive airway pressure on pulmonary hemodynamics. Respiration 2001;68: 566–572.
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2005
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