Is obstructive sleep apnea associated with increased arterial stiffness in patients with COPD?

PURPOSE: To evaluate arterial stiffness, a predictor of vascular damage was assessed by means of pulse wave velocity (PWV) in patients with chronic obstructive pulmonary disease (COPD) and comorbid obstructive sleep apnea (OSA), namely overlap syndrome (OS). METHODS: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography in the laboratory. A clinical assessment was performed according to a strict protocol, including two COPD questionnaires: the COPD assessment test and the modified Medical Research Council scale. COPD severity was graded according to the guidelines of the Global Initiative for Chronic Obstructive Lung Disease. Arterial stiffness was assessed by means of PWV, using a standard technique. RESULTS: Of 102 patients with COPD, 51 had associated OSA. The OS group had more men than the COPD group (73% vs. 47%, respectively; p < 0.01). Both groups had similar ages (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Hypertension was found in 22% of COPD patients, as opposed to 17% patients in the OS group (p = 0.29). High PWV values were present in 42% of the patients. Patients with COPD and OS had the same PWV values (9.8 vs. 10.5 m/s, p = 0.34). There were no differences in central blood pressure, peripheral blood pressure, and augmentation index between the two groups (p > 0.05). CONCLUSION: High PWV values were frequently observed in patients with COPD. However, there was no difference in PWV between patients with OS and those with COPD alone.

Sleep quality in COPD patients: correlation with disease severity and health status.

OBJECTIVE: To evaluate clinical predictors of poor sleep quality in COPD patients with and without obstructive sleep apnea (OSA). METHODS: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography; for sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI); and for disease impact by means of the COPD Assessment Test. COPD severity was graded in accordance with the 2020 GOLD guidelines. Predictors of poor sleep quality were evaluated by multivariate logistic regression analysis. RESULTS: We studied 51 patients with COPD alone and 51 patients with COPD and OSA. Both groups had similar age (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Poor sleep quality was present in 74.8% of the study participants, with no significant difference between COPD patients with and without OSA regarding PSQI scores (p = 0.73). Polysomnography showed increased stage 1 non-rapid eye movement sleep and arousal index, as well as reduced sleep efficiency and stage 3 non-rapid eye movement sleep, in the group of patients with COPD and OSA (p < 0.05). Independent predictors of poor sleep quality were GOLD grade C/D COPD (OR = 6.4; 95% CI, 1.79-23.3; p < 0.01), a COPD Assessment Test score ≥ 10 (OR = 12.3; 95% CI, 4.1-36.5; p < 0.01), and lowest SaO2 < 80% (p < 0.0001). CONCLUSIONS: Poor sleep quality is quite common in patients with COPD and is associated with severe COPD and poor health status, having a negative impact on overall quality of life. Despite changes in polysomnography, OSA appears to have no impact on subjective sleep quality in COPD patients.

Sleep quality in COPD patients: correlation with disease severity and health status / Qualidade do sono em pacientes com DPOC: correlação com gravidade da doença e estado de saúde

To evaluate clinical predictors of poor sleep quality in COPD patients with and without obstructive sleep apnea (OSA). Methods: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography; for sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI); and for disease impact by means of the COPD Assessment Test. COPD severity was graded in accordance with the 2020 GOLD guidelines. Predictors of poor sleep quality were evaluated by multivariate logistic regression analysis. Results: We studied 51 patients with COPD alone and 51 patients with COPD and OSA. Both groups had similar age (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Poor sleep quality was present in 74.8% of the study participants, with no significant difference between COPD patients with and without OSA regarding PSQI scores (p = 0.73). Polysomnography showed increased stage 1 non-rapid eye movement sleep and arousal index, as well as reduced sleep efficiency and stage 3 non-rapid eye movement sleep, in the group of patients with COPD and OSA (p < 0.05). Independent predictors of poor sleep quality were GOLD grade C/D COPD (OR = 6.4; 95% CI, 1.79-23.3; p < 0.01), a COPD Assessment Test score ≥ 10 (OR = 12.3; 95% CI, 4.1-36.5; p < 0.01), and lowest SaO2 < 80% (p < 0.0001). Conclusions: Poor sleep quality is quite common in patients with COPD and is associated with severe COPD and poor health status, having a negative impact on overall quality of life. Despite changes in polysomnography, OSA appears to have no impact on subjective sleep quality in COPD patients.

Avaliar os preditores clínicos de má qualidade do sono em pacientes com DPOC, com e sem apneia obstrutiva do sono (AOS). Métodos: Pacientes estáveis consecutivos com DPOC foram avaliados quanto à AOS por meio de polissonografia noturna; quanto à qualidade do sono por meio do Índice de Qualidade do Sono de Pittsburgh (IQSP) e quanto ao impacto da doença por meio do Teste de Avaliação da DPOC. A gravidade da DPOC foi classificada conforme as diretrizes de 2020 da GOLD. Os preditores de má qualidade do sono foram avaliados por meio de análise de regressão logística multivariada. Resultados: Foram estudados 51 pacientes com DPOC apenas e 51 pacientes com DPOC e AOS. Ambos os grupos eram semelhantes quanto à idade (66,2 ± 9,2 anos vs. 69,6 ± 10,7, p = 0,09) e limitação do fluxo aéreo (p = 0,37). Sono de má qualidade esteve presente em 74,8% dos participantes, sem diferença significativa entre os pacientes com DPOC, com e sem AOS, quanto à pontuação no IQSP (p = 0,73). A polissonografia mostrou aumento do estágio 1 do sono non-rapid eye movement e do índice de despertares, bem como redução da eficiência do sono e do estágio 3 do sono non-rapid eye movement nos pacientes com DPOC e AOS (p < 0,05). Os preditores independentes de má qualidade do sono foram DPOC grau C/D da GOLD (OR = 6,4; IC95%: 1,79-23,3; p < 0,01), pontuação ≥ 10 no Teste de Avaliação da DPOC (OR = 12,3; IC95%: 4,1-36,5; p < 0,01) e menor SaO2 < 80% (p < 0,0001). Conclusões: O sono de má qualidade é bastante comum em pacientes com DPOC e apresenta relação com DPOC grave e estado de saúde ruim, além de ter impacto negativo na qualidade de vida global. Não obstante as alterações na polissonografia, a AOS aparentemente não tem impacto na qualidade do sono referida por pacientes com DPOC.

Prevalence of masked hypertension evaluated by home blood pressure monitoring in a large sample of patients with office blood pressure <140/90 mmHg.

AIM: Patients with masked hypertension have a higher incidence of target organ damage, including increased left ventricular mass and carotid atherosclerosis and cardiovascular events when compared with normotensive patients. The adverse cardiovascular risks are even greater in patients already taking antihypertensive medication. OBJECTIVE: To identify the prevalence and clinical characteristics of masked hypertension in a large multicenter Brazilian sample that underwent office and home blood pressure monitoring. METHODS: This was an observational cross-sectional analytical study based on secondary data from the teleMRPA online platform, which included 32 cities from 15 states in the five regions of Brazil. The database included 3704 outpatient participants with office blood pressure <140/90 mmHg who performed home blood pressure monitoring for diagnostic investigation (diagnosis group; n = 1819) or treatment (treatment group; n = 1885) of hypertension in 2018. RESULTS: The prevalence of masked hypertension was 18.0% in the whole studied population and 15.4% and 20.4% in the diagnostic and treatment group, respectively. Masked hypertension was more frequently detected in patients with office blood pressure classified as high normal [systolic blood pressure (SBP) = 130-139 mmHg or diastolic blood pressure (DBP) = 85-89 mmHg], followed by those classified as normal (SBP = 120-129 mmHg or DBP = 80-84 mmHg) and optimal (SBP < 120 mmHg and DBP < 80 mmHg), with respective prevalence of 28.3, 13.4 and 4.4% in the diagnostic group and 30.8, 18.8 and 7.1% in the treatment group. CONCLUSION: Masked hypertension has a significant prevalence among individuals with office blood pressure <140/90 mmHg, which is greater with patients with high normal office blood pressure and even higher in patients already using antihypertensive medication.

Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials.

PURPOSE: This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. METHODS: The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. RESULTS: Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). CONCLUSION: CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.

Effects of acupuncture on obstructive sleep apnea severity, blood pressure control and quality of life in patients with hypertension: A randomized controlled trial.

Obstructive sleep apnea (OSA) is a common condition among patients with hypertension and treatment with continuous positive airway pressure (CPAP) can decrease blood pressure (BP). However, CPAP is not well tolerated by a significant proportion of patients. The authors investigated the effects of acupuncture on OSA severity and BP control in patients with hypertension. Hypertensive patients with mild to moderate OSA (apnea-hypopnea index, 5-30 events/hr) were randomly assigned to receive acupuncture or sham-acupuncture treatment. Patients were assessed at baseline and after 10 acupuncture sessions using polysomnography, 24-hr ambulatory BP monitoring and a quality of life questionnaire. Forty-four patients (34% men; mean age, 57.0 ± 5.4 years; body mass index, 29.6 ± 3.2 kg/m2 ; apnea-hypopnea index, 16.3 ± 6.7 events/hr) completed the study. There were no differences in pre-post-intervention apnea-hypopnea index, daytime or nocturnal BP, or quality of life between the acupuncture and sham-acupuncture groups (p > .05). Acupuncture therapy in hypertensive patients with OSA did not reduce OSA severity, daytime or nocturnal BP, or quality of life.

Prevalence of Obstructive Sleep Apnea and Obesity Among Middle-Aged Women: Implications for Exercise Capacity.

STUDY OBJECTIVES: The aim of the current study was to evaluate the association between obstructive sleep apnea (OSA) and exercise capacity in middle-aged women. METHODS: Consecutive middle-aged female subjects without cardiovascular disease, aged 45 to 65 years, from two gynecological clinics underwent detailed clinical evaluation, portable sleep study, and treadmill exercise test. RESULTS: We studied 232 women (age: 55.6 ± 5.2 years; body mass index [BMI]: 28.0 ± 4.8 kg/m2). OSA (apnea-hypopnea index ≥ 5 events/h) was diagnosed in 90 (39%) and obesity (BMI > 30 kg/m2) in 76 (33%) women, respectively. Participants with OSA were older, had a higher BMI, and an increased frequency of arterial hypertension compared to women without OSA. Multiple logistic regression models were used to evaluate the association between OSA and exercise capacity, controlling for traditional risk factors including BMI, age, hypertension, diabetes, and sedentary lifestyle. In multivariate analysis, the presence of obesity without OSA was associated with low exercise capacity (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.11, P = .045), whereas the presence of OSA without obesity was not (OR 1.07, 95% CI 0.31-3.69, P = .912). However, the coexistence of obesity and OSA increased markedly the odds of reduction in exercise capacity (OR 9.40, CI 3.79-23.3, P < .001). CONCLUSIONS: Obesity and OSA are common conditions in middle-aged women and may interact to reduce exercise capacity. These results highlight the importance of obesity control programs among women, as well as the diagnosis of comorbid OSA in older women.

Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women.

PURPOSE: Obstructive sleep apnea (OSA) is associated with coronary disease among men. However, this association is not clear for women. In this study, we evaluate the association between OSA and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in middle-aged women. METHODS: We evaluated consecutive women aged between 45 and 65 years in perimenopause or postmenopause period (with menstrual irregularity-amenorrhea > 60 days), without manifest cardiovascular disease (heart failure, coronary disease, and stroke), from two gynecologic clinics. All patients underwent clinical evaluation, computed tomographic examination for coronary artery calcium (CAC > 100 Agatston units), and portable sleep study. Multiple logistic regression models were used to evaluate the association between OSA and CAC, controlling for traditional risk factors including Framingham Risk Score (FRS), body mass index (BMI), and diabetes. RESULTS: We studied 214 women (age 56 years (52-61); BMI 28 kg/m2 (25-31), 25 % diabetes, 62 % hypertension). OSA (apnea-hypopnea index (AHI) ≥5 events/h) was diagnosed in 82 women (38.3 %). CAC was more prevalent in patients with moderate/severe OSA (AHI ≥15 events/h) than in patients without or with mild OSA, 19 % vs 4.5 and 1.6 %, respectively (p < 0.01). Moderate to severe OSA was associated with CAC in unadjusted (odds ratio = 6.25, 95 % CI 1.66-23.52; p < 0.01) and adjusted (odds ratio = 8.19, 95 % CI 1.66-40.32; p = 0.01) logistic regression analysis. CONCLUSION: Moderate to severe OSA is independently associated with the presence of CAC in middle-aged women. These results reinforce the concept that women are also susceptible to the cardiovascular consequences of OSA.

OSA is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women.

BACKGROUND: Perimenopause is associated with increased cardiovascular risk. OSA is an emerging risk factor for cardiovascular disease, particularly among men, but the independent contribution of OSA to cardiovascular risk in climacteric women is not clear. METHODS: We evaluated 277 consecutive women (age, 56 [52-61] years; BMI, 28 [25-32] kg/m2) without manifest cardiovascular disease (heart failure, coronary disease, or stroke). All women underwent 24-h ambulatory BP monitoring, arterial stiffness evaluation (pulse wave velocity), and portable sleep study. RESULTS: OSA (apnea-hypopnea index ≥ 5 events/h) and moderate to severe OSA (apnea-hypopnea index ≥ 15 events/h) were diagnosed in 111 (40.1%) and 31 (11.1%) women, respectively. None of the participants had received a previous diagnosis of OSA. Women with moderate to severe OSA vs those without OSA had a higher prevalence of hypertension, were prescribed more medications for hypertension, had higher awake BP (systolic, 133 [125-142] vs 126 [119-134] mm Hg [P < .01]; diastolic, 82 [78-88] vs 79 [74-85] mm Hg [P = .07]), higher nocturnal BP (systolic, 125 [118-135] vs 115 [109-124] mm Hg [P < .01]; diastolic, 73 [69-79] vs 69 [62-75] mm Hg [P < .01]), and more arterial stiffness (pulse wave velocity, 11.5 [10.1-12.3] m/s vs 9.5 [8.6-10.8] m/s, P < .001). Oxygen desaturation index during the night was independently associated with 24-h arterial BP and arterial stiffness (per five-unit increase in oxygen desaturation index, ß = 1.30 [95% CI, 0.02-2.54; P = .04] vs 0.22 [95% CI, 0.03-0.40; P = .02] in women with vs without OSA, respectively). CONCLUSIONS: OSA is common, underdiagnosed, and independently associated with high BP and increased arterial stiffness in perimenopausal women.