Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea OSA in moderate to severe chronic obstructive pulmonary disease COPD: The challenge to predict OSA in advanced COPDReport as inadecuate




Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea OSA in moderate to severe chronic obstructive pulmonary disease COPD: The challenge to predict OSA in advanced COPD - Download this document for free, or read online. Document in PDF available to download.

The combination of chronic obstructive pulmonary disease COPD and obstructive sleep apnea OSA is associated with substantial morbidity and mortality. We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population. Therefore, we investigated associations between traditional OSA risk factors e.g. age, and sleep questionnaires e.g. Epworth Sleepiness Scale in 44 patients with advanced COPD. As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD. In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events e.g. atrial fibrillation, and sleep questionnaires e.g. Pittsburgh Sleep Quality Index PSQI. For the pilot questionnaire, a BMI ≥25 kg-m2 and the presence of cardiovascular disease were used to construct the pilot screening test. Male: 59%; OSA 66%. FEV1 mean ± SD = 41.0±18.2% pred., FEV1-FVC = 41.5±12.7%. Male gender, older age, and large neck circumference were not associated with OSA. Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression. In contrast, BMI ≥25 kg-m2 OR = 3.94, p = 0.04 and diagnosis of cardiovascular disease OR = 5.06, p = 0.03 were significantly associated with OSA area under curve AUC = 0.74. The pilot COPD-OSA test OR = 5.28, p = 0.05 and STOP-Bang questionnaire OR = 5.13, p = 0.03 were both associated with OSA in Receiver Operating Characteristics ROC analysis. The COPD-OSA test had the best AUC 0.74, sensitivity 92%, and specificity 83%. A ten-fold cross-validation validated our results.We found that traditional OSA predictors e.g. gender, Epworth score did not perform well in patients with more advanced COPD. Our pilot test may be an easy to implement instrument to screen for OSA. However, a larger validation study is necessary before further clinical implementation is warranted.



Author: Xavier Soler , Shu-Yi Liao , Jose Maria Marin, Geraldo Lorenzi-Filho, Rachel Jen, Pamela DeYoung, Robert L. Owens, Andrew L. Ries

Source: http://plos.srce.hr/



DOWNLOAD PDF




Related documents