الفهرس 
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Abstract
COPD and OSA are frequently co-existing diseases resulting in poor clinical outcomes. Therefore, the early diagnosis and the treatment of overlap syndrome are vital issues. Special approach for the determined risk factors and defining related parameters are of great importance.
The aim of this study is to evaluate the prevalence of obstructive sleep apnea in chronic obstructive pulmonary disease patients and its impact on outcome.
The study was conducted at Chest Department in Sohag University Hospital included 121 patients, 66 (54.54%) female and 55 (45.45%) male. Patients were divided into 3 groups, COPD group (48 patients), OSA group (35 patients) and overlap syndrome group (38 patients). The mean age among the studied population was 65.08 years among COPD patients, 59.05 years in overlap syndrome patients and 49.51 years in obstructive sleep apnea (OSA) patients, 29.17% of the patients were females and 70.83% of the patients were males as regard COPD group, 65.79% of cases were females and 34.21% of cases were males as regard overlap syndrome patients and 77.14% of cases were females and 22.68% of cases were males as regard OSA patients.
The mean BMI was 28.92 Kg/m2 among COPD group, 41.73 Kg/m2 among OSA group and 42.11 Kg/m2 among overlap group. The mean waist circumference was 88.06 cm among COPD group, 115.99 cm among OSA group and 109.78 cm among overlap syndrome group. The mean neck circumference was 38.73 cm among COPD group, 37.97 cm among OSA group and 39.93 cm among overlap syndrome group.
The mean FEV1 % of predicted was 45.18% in COPD group, 34.17% in overlap syndrome group and 69.31% in OSA group (P .0001). The mean FVC % of predicted was 61% in COPD group, 48.69% in overlap syndrome group and 69.91% in OSA group (P .0001). The mean FEV1/FVC % of predicted was 62.49% in COPD group, 67.24% in overlap syndrome group and 99.39% in OSA group (< .0001). 43.75% of COPD group and 15.79% of overlap syndrome group were classified according to airway limitation to moderate (stage Ⅱ) COPD. 25% of COPD patients and 13.16% of overlap syndrome patients were classified according to airway limitation to severe (stage Ⅲ) COPD. 31.25% of COPD patients and 71.05% of overlap syndrome patients were classified as very severe (stage Ⅳ) COPD.
The parameters of arterial blood gases were as the following: the mean PH level was 7.37 in COPD group, 7.33 in overlap syndrome group and 7.39 in OSA group (P .01). The mean PaCo2 level was 50.61 mmHg in COPD group, 63.21 mmHg in overlap syndrome group and 42.36 mmHg in OSA group (P .0001). The mean PaO2 level was 63.13 mmHg in COPD group, 54.05 mmHg in overlap syndrome group and 68.91 mmHg in OSA group (P .004). The mean SaO2 level was 83.19% in COPD group, 77.72% in overlap syndrome group and 88.51% in OSA group (P .01). The mean HCO3 level was 26.57 mEq/L in COPD group, 30.86 mEq/L in overlap syndrome group and 25.87 mEq/L in OSA group (P < .0001).
Polysomnography results were as the following: the mean value of Apnea-hypopnea index was 2.89 in COPD group, 45.55 in overlap syndrome group and 44.90 in OSA group (P .0001). 21.05% of overlap syndrome group and 20% of OSA group had mild sleep apnea. 15.79% of overlap syndrome group and 8.57% of OSA group had moderate sleep apnea. 63.16% of overlap syndrome group and 65.71% of OSA group had severe sleep apnea. The mean value of RDI was 2.68 in COPD group, 45.48 in overlap syndrome group and 44.97 in OSA group (P .0001). The mean value of sleep efficiency was 82.83% in COPD group, 86.92% in overlap syndrome group and 80.43% in OSA group. Mean value of sleep latency was 13.66 min in COPD group, 10.8 min in overlap syndrome group and 17.45 min in OSA group. The mean value of oxygen desaturation index was 8.43 in COPD group, 58.24 in overlap syndrome group and 66.16 in OSA group (P .0001).
As regard severity of OSA, 21.05% of overlap syndrome group had mild sleep apnea. 15.79% of overlap syndrome group had moderate obstructive sleep apnea. 63.16% of overlap syndrome group had severe obstructive sleep apnea.
The Epworth sleepiness scale results were as the following: the mean value of Epworth sleepiness scale was 4.29 in COPD group, 13.18 in overlap syndrome group and 13.26 in OSA group (P .0001). The mean value of Pittsburgh sleep quality index (PSQI) was 6.38 in COPD group, 11.63 in overlap syndrome group and 11.91 in OSA group (P .0001).
The most common comorbidities were: hypertension in 35.42% of COPD group, 60.53% of overlap syndrome group and 40% of OSA group . Hyperlipidemia was recorded in 14.58% of COPD group, 57.98% of overlap syndrome group and 57.14% of OSA group (P < .0001). Diabetes mellitus in 29.17% of COPD group, 34.21% of overlap syndrome group and 28.71% of OSA group. IHD was recorded in 22.92% of COPD group, 28.95% of overlap syndrome group and 14.29% of OSA group. Hypothyroidism was recorded in 26.32% of overlap syndrome group, 5.71% of OSA group and non of COPD patients had hypothyroidism (P < .0001). Renal diseases were recorded in 10.42% of COPD group, 7.89% of overlap syndrome group and 2.86% of OSA group. Cerebrovascular diseases were reported in 4.17% of COPD group, 10.53% of overlap syndrome group and non of OSA patients had cerebrovascular disease. Hepatic diseases in 6.25% of COPD group, 5.26% of overlap syndrome group and 2.86% of OSA group and lastly, 20.83% of COPD group, 97.37% of overlap group and 97.14% of OSA group were obese.
The prevalence of OSA among COPD cases was 44.19% of COPD cases had OSA and there was higher prevalence of severe OSA in studied COPD patients than mild and moderate OSA. As regard ICU admission and outcome, 22.92% of COPD group and 63.16% of overlap syndrome group needed ICU admission (P <.0001). 97.91% of COPD group, 94.73% of overlap syndrome group and all OSA cases survived. 2.08% of COPD and 5.26% of overlap syndrome died. There was higher frequency of ICU admission and deaths among severe OSA cases in comparison to mild and moderate OSA cases but this relation is statistically insignificant.
As regard predictors of overlap syndrome in COPD patients, Epworth sleepiness scale (P <.0001, CI 1.32:2.23, odds ratio 1.72) and BMI (P .01, CI 1.03:1.22, odds ratio 1.12) are the most significant predictors for overlap syndrome.
Conclusion
Conclusion
from our study we concluded that:
• Epworth sleepiness scale and BMI are the most significant predictors for overlap syndrome.
• Prevalence of OSA among COPD cases was 44.19% of COPD cases had OSA.
• Prevalence of severe OSA in studied COPD patients higher than mild and moderate OSA.
• The most common comorbidities in overlap syndrome were hypertension followed by hyperlipidemia, DM, IHD, hypothyroidism, cerebrovascular diseases, renal and hepatic diseases.
• The most common comorbidities in COPD were hypertension followed by DM, IHD, hyperlipidemia, renal diseases, hepatic diseases, and cerebrovascular diseases.
• The most common comorbidities in OSA were hyperlipidemia followed by hypertension, DM, IHD, hypothyroidism, renal diseases and hepatic diseases.
• Frequency of ICU admission is higher in overlap syndrome than COPD and OSA cases.
• Frequency of ICU admission is higher in overlap syndrome cases with severe OSA than overlap syndrome cases with mild and moderate OSA.
• Incidence of mortality is higher in overlap syndrome than COPD and OSA.
• Incidence of mortality is higher in overlap syndrome cases with severe OSA than overlap syndrome with mild and moderate OSA.
Recommendations & Limitaions
Recommendations
• Early diagnosis and treatment of overlap syndrome is of great importance.
• Early detection and treatment of OSA risk factors of among COPD patients to improve outcome of the patients.
Limitations
• Sleep lab is not available in our department so polysomnography performance was at ENT department.
• Limited number of included cases as result of covid-19 pandemic.