Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea

Samuel L Krachman; Rachna Tiwari; Maria Elena Vega; Daohai Yu; Xavier Soler; Fredric Jaffe; Victor Kim; Irene Swift; Gilbert E D'Alonzo; Gerard J Criner; COPDGene Investigators

doi:10.1513/AnnalsATS.201511-765OC

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Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea

Journal article

Open access

Peer reviewed

Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea

Samuel L Krachman, Rachna Tiwari, Maria Elena Vega, Daohai Yu, Xavier Soler, Fredric Jaffe, Victor Kim, Irene Swift, Gilbert E D'Alonzo, Gerard J Criner, …

Annals of the American Thoracic Society, Vol.13(7), pp.1129-1135

07/2016

DOI: 10.1513/AnnalsATS.201511-765OC

PMCID: PMC5015748

PMID: 27078132

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Abstract

The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated. To evaluate the importance of lung inflation on OSA severity (apnea-hypopnea index [AHI]) in smokers with suspected OSA. Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m(2)) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping. For the group overall, there was evidence of obstructive airway disease by spirometry (FEV1, 1.4 ± 0.5 L, 58 ± 14% predicted) and emphysema by quantitative CT (CT-derived percent emphysema, 11 ± 13%; CT-derived percent gas trapping, 31.6 ± 24.1%). Twenty-nine (57%) of the patients had OSA (AHI, 18 ± 12 events/h). Patients with OSA had a higher BMI but were younger than those without OSA (BMI, 35 ± 9 kg/m(2) vs. 29 ± 7 kg/m(2), respectively [P = 0.007]; age, 56 ± 8 yr vs. 62 ± 9 yr, respectively [P = 0.01]). There was an inverse correlation between the AHI and the CT-derived percent emphysema and CT-derived percent gas trapping, both for the entire group (r = -0.41 [P < 0.01] and r = -0.44 [P < 0.01], respectively) and when just those patients with OSA were evaluated (r = -0.43 [P = 0.04] and r = -0.49 [P = 0.03], respectively). Multiple linear regression revealed that, in addition to CT-derived percent emphysema and CT-derived percent gas trapping, sex and BMI were important in determining the AHI in these patients. In smokers with OSA, increased gas trapping and emphysema as assessed by CT are associated with a decreased AHI. Along with sex and BMI, these measurements may be important in determining the severity of OSA in patients with COPD and may offer a protective mechanism in patients with more advanced disease.

United States

Body Mass Index

Severity of Illness Index

Pulmonary Emphysema - complications

Spirometry

Smokers

Humans

Middle Aged

Linear Models

Male

Tomography, X-Ray Computed

Lung - physiopathology

Pulmonary Emphysema - diagnostic imaging

Polysomnography

Forced Expiratory Volume

Female

Aged

Sleep Apnea, Obstructive - epidemiology

Details

Title: Subtitle: Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea
Creators: Samuel L Krachman - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Rachna Tiwari - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Maria Elena Vega - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Daohai Yu - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Xavier Soler - 2 Department of Pulmonary, Critical Care, and Sleep Medicine University of California, San Diego, San Diego, California
Fredric Jaffe - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Victor Kim - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Irene Swift - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Gilbert E D'Alonzo - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
Gerard J Criner - 1 Department of Pulmonary, Critical Care, and Sleep Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
COPDGene Investigators
Contributors: Eric A Hoffman (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: Annals of the American Thoracic Society, Vol.13(7), pp.1129-1135
DOI: 10.1513/AnnalsATS.201511-765OC
PMID: 27078132
PMCID: PMC5015748
NLM abbreviation: Ann Am Thorac Soc
ISSN: 2325-6621
eISSN: 2325-6621
Publisher: American Thoracic Society; United States
Grant note: U01 HL089856 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS K23 HL094696 / NHLBI NIH HHS
Language: English
Date published: 07/2016
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984051894002771

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