Prevalence of Overlap Syndrome. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease. A study protocol.
Oliveira, Julio Cesar Mendes; Silva, Anderson Soares; Beloto, Ana Carolina Negrinho de Oliveira; Urbano, Jessica Julioti; Oliveira, Ezequiel Fernandes; Perez, Eduardo Araujo; Peixoto, Roger André Oliveira; Santos, Israel Reis; Oliveira, Luis Vicente Franco
Introduction: Chronic obstructive pulmonary disease (COPD) and Obstructive sleep apnea (OSA) cause an inflammatory response and hypoxia. Patients who have both conditions have increased morbidity and mortality. Overlap syndrome between OSA and COPD is important but under-recognised. Objectives: We aimed to determine the prevalence and severity of overlap syndrome in patients with COPD through the overnight standard polysomnography. Methods/Design: A consecutive single-center cross-sectional study will be performed. The design, conduct and report of this study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The sample will be of convenience, recruited consecutively with respiratory complaints that seek care in a private clinic specializing in pulmonology in the city of Cascavel, in the state of Paraná, from September 2016 to July 2017. All subjects will be submitted to the same evaluation protocol described subsequently. Initially will be collected data on baseline demographic, anthropometric and clinical aspects, including body mass index, neck, hip and waist circumferences, respiratory and cardiac rates, peripheral blood pressure, and BODE index. After this phase of the study, patients will perform lung function tests through petismography, sleep studies using the standard overnight PSG, and respond to the Berlin and Pittsburgh questionnaires, and Epworth Sleepiness Scale.
1. National Institutes of Health (NIH), National Heart Lung and Blood Institute (NHLBI), World Health organization (WHO). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (GOLD). NHLBI/WHO Workshop Report. www.goldcopd.com/workshop/ index.html. 2007 and update in 2008.
2. Fabri LM, Hurd SS, For the GOLD Scientific Committee. Editorial: Global strategy for the diagnosis, management and prevention of COPD: 2003 update. Eur J Respir 2003; 22:1-2.
3. Jardim JRB, Oliveira JCA, Nascimento O. II Consenso Brasileiro sobre Doença Pulmonar Obstrutiva Crônica. J Bras Pneumol 2004; 30: S1-S42.
4. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095-128.
5. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11): e442.
6. Flenley DC. Sleep in chronic obstructive lung disease. Clin Chest Med, 6 (1985), pp. 51–610
7. Soler X, Gaio E, Powell FL, Ramsdell JW, Loredo JS, Malhotra A et al. High prevalence of obstructive sleep apnea in patients with moderate to severe chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2015;12(8):1219-25.
8. Soler-Cataluna JJ et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60(11):925-931.
9. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970- 2002. JAMA 2005; 294(10): 1255-9.
10. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2000; 160(11): 1683-9.
11. 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(17): 1230-5.
12. 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(1): 82-6.
13. Shepard JW, Jr., Garrison MW, Grither DA, Evans R, Schweitzer PK. Relationship of ventricular ectopy to nocturnal oxygen desaturation in patients with chronic obstructive pulmonary disease. Am J Med 1985; 78(1): 28-34.
14. Bradley TD, Rutherford R, Grossman RF, et al. Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 1985; 131(6): 835-9.
15. Weitzenblum E, Krieger J, Apprill M, et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 1988; 138(2): 345-9.
16. Trask CH, Cree EM. Oximeter studies on patients with chronic obstructive emphysema, awake and during sleep. N Engl J Med 1962;266:639-642.
17. Pierce AK et al. Respiratory function during sleep in patients with chronic obstructive lung disease. J Clin Invest 1966; 45 (5):631-636.
18. Hawrylkiewicz I et al. Pulmonary haemodynamics in patients with OSAS or an overlap syndrome. Monaldi Arch Chest Di. 2004;61(3):148-152
19. Owens RL and Malhotra A. Sleep-disordered breathing and COPD: The overlap syndrome. Resp Care 2010;55(10): 1333-1346
20. Sanders MH et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003;167(1):7–14
21. Marin JM et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome Am J Respir Crit Care Med 2010 Aug 1;182(3):325-31. doi: 10.1164/rccm.200912-1869OC. Epub 2010 Apr 8.
22. Lavie P et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995;18(3):149-157
23. McNicholas WT and Fitzgerald MX. Nocturnal deaths among patients with chronic bronchitis and emphysema. BMJ (Clin Res Ed) 1984; 289(6449):878
24. Mermigkis C et al. Health-related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome). Int J Clin Pract 2007;61(2): 207-211
25. Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932-46.
26. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007;370:765-73.
27. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleepdisordered breathing in adults. Am J Epidemiol 2013;177:1006-14.
28. Celli BR, Halbert RJ, Isonaka S, et al. Population impact of different definitions of airway obstruction. Eur Respir J 2003;22:268-73.
29. Lévy P, Kohler M, McNicholas WT, et al. Obstructive sleep apnoea syndrome. Nature Reviews Disease Primers 2015;1:1-20.
30. Tufik S, Santos-Silva R, Taddei JA, et al. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010;11:441-6.
31. Calderón E, Carmona C, Arenas M, Fuentes MA, Sánchez A, Capote F. Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crônica con y sin síndrome de apneas obstructivas durante el sueno. Arch Bronconeumol. 1999;35: 539–43.
32. Gullu Z, Itil O, Oztura I, Aslan O, Ceylan E, Baklan B et al. Kronik obstruktif akciger hastaligi ve obstruktif uyku apne sendromu birlikteligi (overlap sendromu). Turk Toraks Dergisi. 2002;2: 161–7.
33. Venkateswaran S, Tee A. Overlap syndrome between chronic obstructive pulmonary disease and obstructive sleep apnoea in a Southeast Asian teaching hospital. Singapore Med J. 2014 Sep;55: 488–92.
34. Kokturk O, Tathcıoglu T, Fırat H, Cetin N. “Overlap Sendromu” kronik obstruktif akciger hastalarında obstruktif sleep apne sendromu. Tuberkuloz Ve Toraks. 1996;44: 187–92.
35. Resta O, Foschino Barbaro MP, Brindicci C, et al. Hypercapnia in overlap syndrome: possible determinant factors. Sleep Breath. 2002;6: 11–8.
36. McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Am J Respir Crit Care Med 2009;180:692-700.
37. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007; 18(6):805-35
38. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176:532-55.
39. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD. Available at: http://www.goldcopd. org/ (accessed 08 Dec 2016).
40. Hingorjo MR, Qureshi MA, Mehdi A. Neck circumference as a useful marker of obesity: A comparison with body mass index and waist circumference. J Pak Med Assoc 2012;62(1):36-40.
41. Vallianou NG, Evangelopoulos AA, Bountziouka V, et al. Neck circumference is correlated with triglycerides and inversely related with HDL cholesterol beyond BMI and waist circumference. Diabetes Metab Res Rev 2013;29:90–97.
42. Gabrielsen AM, Lund MB, Kongerud J, Viken KE, Røislien J, Hjelmesæth J. The relationship between anthropometric measures, blood gases, and lung function in morbidly obese white subjects. Obes Surg. 2011 Apr;21(4):485-91.
43. Diretrizes para Testes de Função Pulmonar. J Pneumol 2002; 28: S166- 206.
44. American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166:111-17.
45. 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 1994, 7(6):1197-8.
46. Pereira CAC: II Consenso Brasileiro de Espirometria. J Pneumol 2002, 28(3):S1-S82.
47. Celli BR, Cote CG, Marin JM, et. al. The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004 Mar 4;350(10):1005-12.
48. Rechtschaffen A, Kales A: A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information Service/Brain Research Institute; 1968. Psychiatry and Clinical Neurosciences. 2001; 55:305–310.
49. Iber C, Ancoli-Israel S, Chesson Jr A, Quan S: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester: merican Academy of Sleep Medicine; 2007.
50. American Academy of Sleep Medicine. The international classification of sleep disorders: diagnostic and coding manual. 2nd ed. Westchester (IL): Author; 2014.
51. International Classification of Sleep Disorders, 3rd ed. Darien, IL, American Academy of Sleep Medicine, 2014.
52. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.
53. Murray WJ: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545.
54. Murray WJ: Reliability and factor analysis of Epworth sleepiness scale. Sleep. 1992; 15(4):376-81.
55. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP: Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999, 131(7):485-491.
56. Becker HF, Piper AJ, Flynn WE, et al. Breathing during sleep in patients with nocturnal desaturation. Am J Respir Crit Care Med. 1999;159(1):112-118. 19.