Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review.
The objective of this systematic review is to synthesize the evidence on prevalence, polysomnographic findings and clinical outcomes of co-morbid obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) - known as the "overlap syndrome". We systematically searched PubMed on 1 December 2015 using appropriate medical subject headings (MeSH) and text words to capture prevalence studies and comparative studies of any observational design examining the clinical outcomes in patients with co-existent COPD and OSA. We reviewed 591 articles and included 27 in the final review. In total, 21 observational studies (n = 29,341 participants) provided prevalence estimates. Overlap syndrome is not common in the general and hospital population (range: 1.0-3.6%), but is highly prevalent in patients diagnosed with either obstructive sleep apnea (range: 7.6-55.7%) or COPD (range: 2.9-65.9%). Overlap syndrome patients have been shown to have greater nocturnal oxygen desaturation (NOD) (i.e., reduced mean peripheral capillary oxygen saturation (SpO2) and increased sleep time spent with SpO2< 90% (T90)) and worse sleep quality than patients with only OSA. It is associated with more frequent cardiovascular morbidity, poorer quality of life (QoL), more frequent COPD exacerbation and increased medical costs. This systematic review on overlap syndrome highlights the limitations and knowledge gaps of its prevalence, etiology and underlying pathophysiologic mechanisms related to increased morbidity and mortality.
Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden. Electronic address: md.shawon@stud.ki.se.
Md Shajedur R
MS
Shawon
Allergy and Lung Health Unit, Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia; Institute for Breathing & Sleep (IBAS), Heidelberg, Victoria 3084, Australia. Electronic address: j.perret@student.unimelb.edu.au.
Jennifer L
JL
Perret
Allergy and Lung Health Unit, Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia; Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. Electronic address: chamaravs@sjp.ac.lk.
Chamara V
CV
Senaratna
Allergy and Lung Health Unit, Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia. Electronic address: clodge@unimelb.edu.au.
Caroline
C
Lodge
Department of Lung and Sleep Medicine at Monash Health, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, Victoria 3168, Australia. Electronic address: garun.hamilton@monashhealth.org.
Garun S
GS
Hamilton
Allergy and Lung Health Unit, Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Level 3, 207 Bouverie Street, Victoria 3010, Australia. Electronic address: s.dharmage@unimelb.edu.au.
Shyamali C
SC
Dharmage
D002318:Cardiovascular Diseases; D015897:Comorbidity; D006801:Humans; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*
Chronic obstructive pulmonary disease (COPD); Clinical outcome; Nocturnal oxygen desaturation (NOD); Obstructive sleep apnea (OSA); Overlap syndrome; Polysomnography; Prevalence