Abstract
We assessed the effects of chronic nasal continuous positive airway pressure (CPAP) therapy on lung function in a series of unselected patients with overlap syndrome, and we determined whether there were differences in the response induced by CPAP between hypercapnic (PaCO2 ≥ 45 mm Hg) and eucapnic patients with overlap syndrome. The study population included 55 unselected patients (48 men, mean age of 58.5 ± 10.5 years) with a concurrent diagnosis of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea-hypopnea syndrome (OSAHS) who had been referred to the Department of Pulmonology of our hospital over 2 consecutive years and in whom work-up studies resulted in the prescription of nasal CPAP therapy. An apnea-hypopnea index (AHI) greater than or equal to 10 in the cardiorespiratory polygraphy was required for the diagnosis of OSAHS. A forced expiratory volume in one second (FEV1) less than 80% and FEV1-forced vital capacity (FVC) ratio less than 70% of the reference values were required for the diagnosis of COPD. Control lung function studies and arterial blood gas measurements were performed at 6 and 18 months of CPAP therapy. These patients with overlap syndrome accounted for 28.5% of all patients with OSAHS treated with CPAP during the study period. The mean AHI was 37.3 ± 26.1 and the mean CPAP level 7.3 ± 1.3 cm H2O. Thirty-three patients were hypercapnic (PaCO2 ≥ 45 mm Hg) and 22 eucapnic. The hypercapnic group had higher AHI value (44.3 ± 26.9) than the eucapnic group (28.6 ± 21.9) (P < 0.05). After 6 months of CPAP therapy, there were statistically significant increases in PaO2, FEV1, and FVC, accompanied by significant decreases in PaCO2, serum bicarbonate levels, and alveolar-arterial oxygen difference. Response of overlap syndrome patients to CPAP therapy was superior in the hypercapnic group, particularly in relation to improvement of arterial blood gases. However, statistically significant differences in all parameters for the comparison between 6 and 18 months were not recorded.
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References
Flenley DC. Sleep in chronic obstructive lung disease. Clin Chest Med 1985;6:51–61
Catterall JR, Douglas NJ, Calverley PMA, et al. Transient hypoxemia during sleep in chronic obstructive pulmonary disease is not a sleep apnea syndrome. Am Rev Respir Dis 1983;128:24–29
Connaughton JJ, Catterall JR, Elton RA, Stradling JR, Douglas NJ. Do sleep studies contribute to the management of patients with severe chronic obstructive pulmonary disease?. Am Rev Respir Dis 1988;138:341–344
Calderón E, Carmona C, Arenas M, Fuentes MA, Sánchez A, Capote F. Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crónica con y sin síndrome de apneas obstructivas durante el sueño. Arch Bronconeumol 1999;35:539–543
Chaouat A, Weitzenblum E, Krieger J, et al. Prognostic value of lung function and pulmonary haemodynamics in OSA patients treated with CPAP. Eur Respir J 1999;13:1091–1096
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
Mayos M, Hernández L, Farré A, Sanchis J. Efecto de la oxigenoterapia nocturna en el paciente con síndrome de apnea-hipopnea del sueño y limitación crónica al flujo aéreo. Arch Bronconeumol 2001;37:65–68
Sforza E, Krieger J, Weitzenblum E, Apprill M, Lampert E, Ratamaharo J. Long-term effects of treatment with nasal continuous positive airway pressure on daytime lung function and pulmonary hemodynamics in patients with obstructive sleep apnea. Am Rev Respir Dis 1990;141:866–870
Rapoport DM, Sorkin B, Garay SM, Goldring RM. Reversal of the “Pickwickian syndrome” by long-term use of nocturnal nasal-airway pressure. N Engl J Med 1982;307:931–933
Frith RW, Cant BR. Severe obstructive sleep apnoea treated with long-term nasal continuous positive airway pressure. Thorax 1985;40:45–50
Young IH, Mihalyka M, Costas L, Sullivan CE. Long-term lung function changes in patients with obstructive sleep apnoea during treatment with nasal continuous positive airway pressure [abstract]. Thorax 1987;42:722–722
Leech JA, Önal E, Lopata M. Nasal CPAP continues to improve sleep-disordered breathing and daytime oxygenation over long-term follow-up of occlusive sleep apnea syndrome. Chest 1992;102:1651–1655
Vázquez R, Cano S, Capote F, Sánchez MA, Carmona C, Castillo J. Efectos de la presión positiva continua nasal (CPAPn) sobre la función pulmonar en pacientes con síndrome de apnea obstructiva del sueño (SAOS). Arch Bronconeumol 1995;31:18–22
Mansfield D, Naughton MT. Effects of continuous positive airway pressure on lung function in patients with chronic obstructive pulmonary disease and sleep disordered breathing. Respirology 1999;4:365–370
Standards of Practice Committee of the American Sleep Disorders Association. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep 1994;17:372–377
Commission des Communautés Européennes. Aide-mémoire pour la pratique de l’examen de la fonction ventilatoire par la spirographie. Collection d’Hygiènie et de Médecine du Travail 2nd ed. Luxembourg: European Economic Community; 1971
Chan CS, Woolcock AJ, Sullivan CE. Nocturnal asthma: role of snoring and obstructive sleep apnea. Am Rev Respir Dis 1988;137:1502–1504
Nadel JA, Widdicombe JG. Reflex effects of upper airway irritation on total lung resistance and blood pressure. J Appl Physiol 1962;17:861–865
Ryan CF, Lowe AA, Li D, Fleetham JA. Magnetic resonance imaging of the upper airway obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis 1991;144:939–944
Mezzanotte WS, Tangel DJ, Fox AM, Ballard RD, White DP. Nocturnal nasal continuous positive airway pressure in patients with chronic obstructive pulmonary disease. Influence on waking respiratory muscle function. Chest 1994;106:1100–1108
Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis 1982;126:812–817
Petrof BJ, Calderini E, Gottfried SB. Effect of CPAP on respiratory effort and dyspnea during exercise in severe COPD. J Appl Physiol 1990;69:179–188
Petrof BJ, Kimoff RJ, Levy RD, Cosio MG, Gottfried SB. Nasal continuous positive airway pressure facilitates respiratory muscle function during sleep in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1991;143:928–935
Petrof BJ, Legaré M, Goldberg P, Milic-Emili J, Gottfried SB. Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1990;141:281–289
Krachman SL, Quaranta AJ, Berger TJ, Criner GJ. Effects of noninvasive positive pressure ventilation on gas exchange and sleep in COPD patients. Chest 1997;112:623–628
Rossi A, Santos C, Roca J, Torres A, Félez MA, Rodríguez-Roisin R. Effects of PEEP on VA/Q mismatching in ventilated patients with chronic airflow obstruction. Am J Respir Crit Care Med 1994;149:1077–1084
Han F, Chen E, Wei H, et al. Treatment effects on carbon dioxide retention in patients with obstructive sleep apnea-hypopnea syndrome. Chest 2001;119:1814–1819
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de Miguel, J., Cabello, J., Sánchez-Alarcos, J.M.F. et al. Long-Term Effects of Treatment with Nasal Continuous Positive Airway Pressure on Lung Function in Patients with Overlap Syndrome. Sleep Breath 6, 3–10 (2002). https://doi.org/10.1007/s11325-002-0003-6
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DOI: https://doi.org/10.1007/s11325-002-0003-6