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23-06-2022 | Chronic Obstructive Lung Disease | Sleep Breathing Physiology and Disorders • Original Article

Predictive tools for nocturnal respiratory failure in patients with moderate and severe OSAS

Authors: Andrea Portacci, Carla Santomasi, Valentina Di Lecce, Federica Barratta, Maria Luisa De Candia, Onofrio Resta, Giovanna Elisiana Carpagnano

Published in: Sleep and Breathing | Issue 2/2023

Abstract

Purpose

The impact of obstructive sleep apnea syndrome (OSAS) in terms of mortality, morbidity, and quality of life has been well established. Phenotyping OSAS is essential in order to make the best therapeutic choice. A particular subset of patients with OSAS shows nocturnal respiratory failure, defined by a nighttime oxygen saturation <90% in more than 30% of the total sleep time (TST90). The aim of this study was to identify possible predictive factors for nighttime respiratory failure (NRF) in patients with OSAS.

Methods

In this retrospective study, patients with suspected OSAS who underwent a sleep study were enrolled. Of 116 patients with moderate/severe OSAS who met the inclusion criteria, 67 also had nocturnal respiratory failure. We compared clinical, anthropometric, and laboratory data in patients with OSAS vs. OSAS and nocturnal respiratory failure.

Results

Patients with OSAS and nocturnal respiratory failure were more frequently female, had a higher BMI, lower daytime oxygen partial pressure (PaO2) in arterial blood, higher Apnea Hypopnea Index (AHI), and a lower number of sleep hours per night. Chronic obstructive pulmonary disease (COPD) was more diagnosed in the group of patients with nocturnal respiratory failure. A lower number of total sleep hours, lower daytime PaO2, lower AHI, increased oxygen desaturation index (ODI), and the presence of a diagnosed COPD were all found to increase the risk of having nocturnal respiratory failure.

Conclusion

COPD, AHI, ODI, daytime PaO2, and total sleep hours are the main predictors for NRF in patients with moderate and severe OSAS.

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Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. https://doi.org/10.1093/aje/kws342

Xie C, Zhu R, Tian Y, Wang K (2017) Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2016-013983

Baratta F, Pastori D, Fabiani M et al (2018) Severity of OSAS, CPAP and cardiovascular events: a follow-up study. Eur J Clin Investig. https://doi.org/10.1111/eci.12908

Tarasiuk A, Reuveni H (2013) The economic impact of obstructive sleep apnea. Curr Opin Pulm Med. https://doi.org/10.1097/MCP.0b013e3283659e1eCrossRefPubMed

Sullivan CE, Berthon-Jones M, Issa FG, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. https://doi.org/10.1016/S0140-6736(81)92140-1

Rotenberg BW, Murariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. https://doi.org/10.1186/s40463-016-0156-0

Sutherland K, Kairaitis K, Yee BJ et al (2018) From CPAP to tailored therapy for obstructive sleep Apnoea. Multidiscip Respir Med. https://doi.org/10.1186/s40248-018-0157-0CrossRefPubMedPubMedCentral

Zinchuk A, Yaggi HK (2020) Phenotypic subtypes of OSA: a challenge and opportunity for precision medicine. Chest 157:403–420CrossRefPubMed

Levi-Valensi P, Weitzenblum E, Rida Z et al (1992) Sleep-related oxygen desaturation and daytime pulmonary haemodynamics in COPD patients. Eur Respir J

10.

Weitzenblum E, Chaouat A, Charpentier C et al (1997) Sleep-related hypoxaemia in chronic obstructive pulmonary disease: causes, consequences and treatment. Respiration 64:187–193. https://doi.org/10.1159/000196669CrossRefPubMed

11.

Labarca G, Gower J, Lamperti L et al (2020) Chronic intermittent hypoxia in obstructive sleep apnea: a narrative review from pathophysiological pathways to a precision clinical approach. Sleep Breath

12.

Kapur VK, Auckley DH, Chowdhuri S et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13:479–504CrossRefPubMedPubMedCentral

13.

Mokhlesi B, Masa JF, Afshar M et al (2019) Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 200:E6–E24. https://doi.org/10.1164/RCCM.201905-1071STCrossRefPubMedPubMedCentral

14.

McKeon JL, Murree-Allen K, Saunders NA (1988) Prediction of oxygenation during sleep in patients with chronic obstructive lung disease. Thorax 43:312–317. https://doi.org/10.1136/thx.43.4.312CrossRefPubMedPubMedCentral

15.

Kapsimalis F, Kryger MH (2002) Gender and obstructive sleep apnea syndrome, part 1: clinical features. Sleep 25:409–416. https://doi.org/10.1093/SLEEP/25.4.409CrossRef

16.

O'Connor CHRIS, Thornley KS, Hanly PJ (2000) Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 161:1465–1472. https://doi.org/10.1164/AJRCCM.161.5.9904121CrossRefPubMed

17.

Ware JC, McBrayer RH, Scott JA (2000) Influence of sex and age on duration and frequency of sleep apnea events. Sleep 23:1–6. https://doi.org/10.1093/SLEEP/23.2.1CCrossRef

18.

Leech JA, Onal E, Dulberg C, Lopata MA (1988) A comparison of men and women with occlusive sleep apnea syndrome. Chest 94:983–988. https://doi.org/10.1378/CHEST.94.5.983CrossRefPubMed

19.

Basoglu OK, Tasbakan MS (2018) Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath 22:241–249. https://doi.org/10.1007/S11325-017-1482-9CrossRefPubMed

20.

Fletcher EC, Miller J, Divine GW et al (1987) Nocturnal oxyhemoglobin desaturation in COPD patients with arterial oxygen tensions above 60 mm Hg. Chest 92:604–608. https://doi.org/10.1378/chest.92.4.604CrossRefPubMed

21.

Matsumoto T, Murase K, Tabara Y et al (2020) Sleep disordered breathing and metabolic comorbidities across sex and menopausal status in East Asians: the Nagahama study. Eur Respir J 56:1902251. https://doi.org/10.1183/13993003.02251-2019CrossRefPubMed

22.

Lévy P, Pépin JL, Arnaud C, et al (2008) Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J Eur Respir J, 32:1082–1095

23.

Phillips BG, Kato M, Narkiewicz K et al (2000) Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 279:279. https://doi.org/10.1152/ajpheart.2000.279.1.h234CrossRef

24.

Phipps PR, Starritt E, Caterson I, Grunstein RR (2002) Association of serum leptin with hypoventilation in human obesity. Thorax 57:75–76. https://doi.org/10.1136/thorax.57.1.75CrossRefPubMedPubMedCentral

25.

Saad MF, Damani S, Gingerich RL et al (1997) Sexual dimorphism in plasma leptin concentration 1. J Clin Endocrinol Metab 82:579–584. https://doi.org/10.1210/jcem.82.2.3739CrossRefPubMed

26.

Thomas T, Burguera B, Melton LJ et al (2000) Relationship of serum leptin levels with body composition and sex steroid and insulin levels in men and women. Metabolism 49:1278–1284. https://doi.org/10.1053/meta.2000.9519CrossRefPubMed

27.

Lusic Kalcina L, Valic M, Pecotic R et al (2017) Good and poor sleepers among OSA patients: sleep quality and overnight polysomnography findings. Neurol Sci 38:1299–1306. https://doi.org/10.1007/s10072-017-2978-6CrossRefPubMed

28.

Mallon L, Broman JE, Hetta J (2005) High incidence of diabetes in men with sleep complaints or short sleep duration: a 12-year follow-up study of a middle-aged population. Diabetes Care 28:2762–2767. https://doi.org/10.2337/diacare.28.11.2762CrossRefPubMed

29.

Taheri S, Lin L, Austin D et al (2004) Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 1:210–217. https://doi.org/10.1371/journal.pmed.0010062CrossRef

30.

Gottlieb DJ, Redline S, Nieto FJ et al (2006) Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep 29:1009–1014. https://doi.org/10.1093/sleep/29.8.1009CrossRefPubMed

31.

Meier-Ewert HK, Ridker PM, Rifai N et al (2004) Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 43:678–683. https://doi.org/10.1016/j.jacc.2003.07.050CrossRefPubMed

32.

Budhiraja R, Siddiqi TA, Quan SF (2015) Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 11:259–270CrossRefPubMedPubMedCentral

33.

Zamarrón C, Paz VG, Morete E, del Campo Matías F (2008) Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences. Int J COPD 3:671–682CrossRef

34.

McNicholas WT (2000) Impact of sleep in COPD. Chest 117:48S–53S. https://doi.org/10.1378/chest.117.2_suppl.48SCrossRefPubMed

35.

Calverley PMA, Brezinova V, Douglas NJ et al (1982) The effect of oxygenation on sleep quality in chronic bronchitis and emphysema. Am Rev Respir Dis 126:206–210. https://doi.org/10.1164/arrd.1982.126.2.206CrossRefPubMed

36.

Ganga HV, Nair SU, Puppala VK, Miller WL (2013) Risk of new-onset atrial fibrillation in elderly patients with the overlap syndrome: a retrospective cohort study. J Geriatr Cardiol 10:129–134. https://doi.org/10.3969/j.issn.1671-5411.2013.02.001CrossRefPubMedPubMedCentral

37.

Polkey MI, Kyroussis D, Hamnegard CH et al (1996) Diaphragm strength in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 154:1310–1317. https://doi.org/10.1164/ajrccm.154.5.8912741CrossRefPubMed

38.

Begin P, Grassino A (1991) Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease. Am Rev Respir Dis 143:905–912. https://doi.org/10.1164/ajrccm/143.5_pt_1.905CrossRefPubMed

39.

Spruit MA, Gosselink R, Troosters T et al (2003) Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax 58:752–756. https://doi.org/10.1136/thorax.58.9.752CrossRefPubMedPubMedCentral

40.

Carpagnano GE, Kharitonov SA, Foschino-Barbaro MP et al (2004) Supplementary oxygen in healthy subjects and those with COPD increases oxidative stress and airway inflammation. Thorax 59:1016–1019. https://doi.org/10.1136/thx.2003.020768CrossRefPubMedPubMedCentral

41.

Davidson AC, Leach R, George RJD, Geddes DM (1988) Supplemental oxygen and exercise ability in chronic obstructive airways disease. Thorax 43:965–971. https://doi.org/10.1136/thx.43.12.965CrossRefPubMedPubMedCentral

42.

Connaughton JJ, Catterall JR, Elton RA et al (1988) Do sleep studies contribute to the management of patients with severe chronic obstructive pulmonary disease? Am Rev Respir Dis 138:341–344. https://doi.org/10.1164/ajrccm/138.2.341CrossRefPubMed

43.

Fletcher EC, Donner CF, Midgren B et al (1992) Survival in COPD patients with a daytime PaO2 >60 mm Hg with and without nocturnal oxyhemoglobin desaturation. Chest 101:649–655. https://doi.org/10.1378/chest.101.3.649CrossRefPubMed

44.

Machado MCL, Vollmer WM, Togeiro SM et al (2010) CPAP and survival in moderate-to-severe obstructive sleep apnoea syndrome and hypoxaemic COPD. Eur Respir J 35:132–137. https://doi.org/10.1183/09031936.00192008CrossRefPubMed

Title: Predictive tools for nocturnal respiratory failure in patients with moderate and severe OSAS
Authors: Andrea Portacci
Carla Santomasi
Valentina Di Lecce
Federica Barratta
Maria Luisa De Candia
Onofrio Resta
Giovanna Elisiana Carpagnano
Publication date: 23-06-2022
Publisher: Springer International Publishing
Keyword: Chronic Obstructive Lung Disease
Published in: Sleep and Breathing / Issue 2/2023
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02666-3

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