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Erschienen in: Sleep and Breathing 4/2020

02.01.2020 | Sleep Breathing Physiology and Disorders • Original Article

Overlap syndrome: the coexistence of OSA further impairs cardiorespiratory fitness in COPD

verfasst von: Luiz Carlos Soares de Carvalho Junior, Renata Trimer, Katiany Lopes Zangrando, Guilherme Peixoto Tinoco Arêas, Flávia Rossi Caruso, José Carlos Bonjorno Junior, Cláudio Ricardo Oliveira, Renata Mendes, Audrey Borghi-Silva

Erschienen in: Sleep and Breathing | Ausgabe 4/2020

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Abstract

Background

Cardiorespiratory fitness (CRF) is an important prognostic marker in chronic obstructive pulmonary disease (COPD). Obstructive sleep apnea (OSA) also negatively affects exercise tolerance. However, the impact of their association on CRF has not been evaluated. We hypothesized that patients with overlap syndrome would demonstrate a greater impairment in CRF, particularly those with severe COPD.

Methods

Individuals with COPD were recruited. First, subjects underwent clinical and spirometry evaluation. Next, home-based sleep evaluation was performed. Subjects with an apnea-hypopnea index (AHI) < 15 episodes/h were allocated to the COPD group and those with an AHI ≥ 15 episodes/h to the overlap group. On the second visit, subjects underwent a cardiopulmonary exercise test. Subsequently, they were divided into four groups according to the severity of COPD and coexistence of OSA: COPDI/II; overlap I/II; COPDIII/IV; and overlap III/IV.

Results

: Of the 268 subjects screened, 31 were included. The overlap group exhibited higher values for peak carbon dioxide (COPD: 830 [678–1157]; overlap: 1127 [938–1305] mm Hg; p < 0.05), minute ventilation (COPD: 31 [27–45]; overlap: 48 [37–55] L; p < 0.05), and peak systolic blood pressure (COPD: 180 [169–191]; overlap: 220 [203–227] mm Hg; p <; 0.001) and peak diastolic blood pressure COPD: 100 [93–103]; overlap: 110 [96–106] mm Hg; p < 0.001). COPD severity associated with OSA produced a negative impact on exercise time (COPDIII/IV: 487 ± 102; overlap III/IV: 421 ± 94 s), peak oxygen uptake (COPDIII/IV: 12 ± 2; overlap III/IV: 9 ± 1 ml.Kg.min−1 ; p < 0.05) and circulatory power (COPDIII/IV: 2306 ± 439; overlap III/IV: 2162 ±  340 ml/kg/min.mmHg; p < 0.05).

Conclusion

Overlap syndrome causes greater hemodynamic and ventilatory demand at the peak of dynamic exercise. In addition, OSA overlap in individuals with more severe COPD impairs CRF.
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Metadaten
Titel
Overlap syndrome: the coexistence of OSA further impairs cardiorespiratory fitness in COPD
verfasst von
Luiz Carlos Soares de Carvalho Junior
Renata Trimer
Katiany Lopes Zangrando
Guilherme Peixoto Tinoco Arêas
Flávia Rossi Caruso
José Carlos Bonjorno Junior
Cláudio Ricardo Oliveira
Renata Mendes
Audrey Borghi-Silva
Publikationsdatum
02.01.2020
Verlag
Springer International Publishing
Erschienen in
Sleep and Breathing / Ausgabe 4/2020
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-019-02002-2

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