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Cited by 50Obstructive Sleep Apnea ResearchChronic Obstructive Pulmonary Disease (COPD) ResearchRespiratory Support and Mechanisms

Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort

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Donovan, Lucas M., Feemster, Laura C., Udris, Edmunds M., Griffith, Matthew F., Spece, Laura J., Palen, Brian N., He, Ken, Parthasarathy, Sairam +3 more·2019·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.7574PMC PMC6329538
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Abstract

Evaluate consequences of intermediate to high risk of undiagnosed obstructive sleep apnea (OSA) among individuals with chronic obstructive pulmonary disease (COPD). Using data from the Long Term Oxygen Treatment Trial (LOTT), we assessed OSA risk at study entry among patients with COPD. We compared outcomes among those at intermediate to high risk (modified STOP-BANG score ≥ 3) relative to low risk (score < 3) for OSA. We compared risk of mortality or first hospitalization with proportional hazard models, and incidence of COPD exacerbations using negative binomial regression. We adjusted analyses for demographics, body mass index, and comorbidities. Last, we compared St. George Respiratory Questionnaire and Quality of Well-Being Scale results between OSA risk groups. Of the 222 participants studied, 164 (74%) were at intermediate to high risk for OSA based on the modified STOP-BANG score. Relative to the 58 low-risk individuals, the adjusted hazard ratio of mortality or first hospitalization was 1.61 (95% confidence interval 1.01–2.58) for those at intermediate to high risk of OSA. Risk for OSA was also associated with increased frequency of COPD exacerbations (adjusted incidence rate ratio: 1.78, 95% confidence interval 1.10–2.89). Respiratory symptoms by St. George Respiratory Questionnaire were 5.5 points greater (P = .05), and Quality of Well-Being Scale scores were .05 points lower (P < .01) among those at intermediate to high risk for OSA, indicating more severe respiratory symptoms and lower quality of life. Among individuals with COPD, greater risk for undiagnosed OSA is associated with poor outcomes. Increased recognition and management of OSA in this group could improve outcomes. Donovan LM, Feemster LC, Udris EM, Griffith MF, Spece LJ, Palen BN, He K, Parthasarathy S, Strohl KP, Kapur VK, Au DH. Poor outcomes among patients with chronic obstructive pulmonary disease with higher risk for undiagnosed obstructive sleep apnea in the LOTT cohort. J Clin Sleep Med 2019;15(1):71–77.

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  • Overlap syndrome, the concurrent diagnosis of obstructive sleep apnea and chronic obstructive pulmonary disease, is associated with a more severe clinical course than either disease alone.

    “OS is associated with a more severe clinical course compared to either disease alone.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [779]

    The introductory passage reports worse quality of life, mortality, and exacerbations in patients with COPD–OSA overlap compared with patients with COPD alone. The Results compare COPD patients at higher versus lower risk of undiagnosed OSA, not confirmed overlap syndrome against both diseases separately. Our copy does not support the additional comparison with OSA alone. (LLM, conf=0.87)

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Authors
Donovan, L. M., Feemster, L. C., Udris, E. M., Griffith, M. F., Spece, L. J., Palen, B. N., He, K., Parthasarathy, S., Strohl, K. P., Kapur, V. K., & Au, D. H.
Affiliations
  • University of Washington (US)
  • VA Puget Sound Health Care System (US)
  • University of Arizona (US)
  • Case Western Reserve University (US)
Corresponding author
Donovan, Lucas M.
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-01-15
Volume
15
Issue
1
Pages
71-77
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.7574
PMC
PMC6329538
OpenAlex
W2909478855
Semantic Scholar
6fce5f7b4f3c2d4023db523ae9209c9f0d21c907
Cited by
50
References
40
Citations by year
2026: 2 · 2025: 10 · 2024: 8 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 9 · 2019: 4
FWCI
4.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (K12HL137940, F32HL140685, K23HL111116, F32HL142125, T32HL007287)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
chronic obstructive pulmonary disease, obstructive sleep apnea, undiagnosed sleep apnea, COPD exacerbations, hospitalization and mortality, quality of life, respiratory symptoms
MeSH terms
Aged, Female, Humans, Longitudinal Studies, Male, Oxygen Inhalation Therapy, Prospective Studies, Quality of Life, Surveys and Questionnaires, Risk Factors, Time, Cohort Studies, Comorbidity, Incidence, Polysomnography, Sleep Apnea, Obstructive, Pulmonary Disease, Chronic Obstructive

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