Predictive factors warrant screening for obstructive sleep apnea in COPD: a Taiwan National Survey.
OBJECTIVE
COPD and obstructive sleep apnea (OSA) share similar pathological processes and cardiovascular sequelae. Coexisting OSA in COPD - "overlap syndrome" - has worse prognosis than either condition alone, and appropriate treatment improves survival. Our objectives were to ascertain the frequency at which COPD coexists with the risk of OSA in Taiwan and to compare the risk factors, COPD symptoms, and life quality metrics between COPD subgroups with versus without risk of OSA.


METHODS
We conducted a random cross-sectional national telephone survey of adults >40 years old in Taiwan. Participants fulfilling an epidemiological case definition of COPD completed a questionnaire to assess COPD symptoms and OSA risk, comorbidities, and performance of daily activities. Data from COPD cohorts with and without risk of OSA were analyzed and compared.


RESULTS
Of 6,600 interviews completed, 404 subjects fit the epidemiological case definition of COPD - an overall prevalence of 6.1% in this national sample. Data on OSA risk were available for 292 of this COPD cohort, of whom 29.5% were at risk of OSA. Compared to those without risk of OSA, those with risk of OSA were significantly more likely to have hypertension or cardiovascular disease and diabetes, had significantly higher body mass index and COPD Assessment Test scores, and reported impaired work performance and leisure activities.


CONCLUSIONS
Among adults in Taiwan who fulfill epidemiologic criteria for COPD, 29.5% have coexisting risk of OSA. Comorbid hypertension or cardiovascular disease and diabetes are common and significantly more prevalent among the COPD population at risk of OSA than those who are not. OSA screening is warranted in patients with COPD with those risk factors that are more prevalent in COPD with risk of OSA than without, to target early interventions to reduce adverse cardiovascular sequelae from overlap syndrome.
Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Republic of China; Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Republic of China.
Liang-Wen
LW
Hang
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Republic of China.
Jeng-Yuan
JY
Hsu
Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou Branch, Guishan Township, Taoyuan County, Republic of China.
Chee-Jen
CJ
Chang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China; Department of Internal Medicine, National Taiwan University, College of Medicine, Taipei, Republic of China.
Hao-Chien
HC
Wang
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Republic of China; Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li City, Taoyuan County, Republic of China.
Shih-Lung
SL
Cheng
Division of Chest Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Republic of China.
Ching-Hsiung
CH
Lin
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Republic of China.
Ming-Cheng
MC
Chan
Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Republic of China.
Chin-Chou
CC
Wang
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
Diahn-Warng
DW
Perng
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China; Department of Internal Medicine, National Taiwan University, College of Medicine, Taipei, Republic of China.
Chong-Jen
CJ
Yu
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D011788:Quality of Life; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D013624:Taiwan
COPD; OSA; cardiovascular risk; coexistent; obstructive sleep apnea; overlap syndrome