الفهرس 
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Abstract
The coexistence of COPD and OSAS, known as Overlap Syndrome (OS) was first described by David Flenley almost 30 years ago , he pointed out that a sleep study should be considered in obese COPD patients , in those who snore or those who complain of headache following nocturnal oxygen therapy to determine the presence of associated OSA.
The aim of this study was to assess the prevalence of OSA in COPD patients.
This observational study was carried out on 100 subjects of both sexes, with stable COPD who attended to chest department, outpatient clinic Benha university hospitals for follow up in the period between June 2017 and June 2019.
Patients were categorized into two groups;
group A : 75 obese COPD patients (BMI ≥30 kg/m2) .
group B : 25 non obese COPD patients (BMI ≤ 30 kg/m2) .
All patients included in this study were subjected to full history taking & clinical examination (general and local), questionnaires assesement, measurement of oxygen saturation by pulse oximetry, ventillatory pulmonary function tests(spirometry), ECG, Echo cardiography and overnight polysomnography (PSG).
In this study it was found that most of cases were males (78%), median age was 66 and 75% of cases defined as obese with median smoking index of 50 pack/year.
There was statistical significant difference between the studied groups regarding smoking index, BMI, neck circumference as they were significantly higher in obese group. However, there was no statistical significant difference between both groups regarding age or sex distribution . Male gender was higher in both groups.
We found statistically significant difference between obese & non obese groups regarding Pre FEV1, Pre FVC, FEV1/FVC and post FEV1% predicted as they were higher in non obese groups.
There was statistical significant difference between obese and non obese COPD patients regarding disease severity.
This study showed statistical significant difference between the studied groups (COPD and OSA) regarding AHI, RDI & oxygen desaturation index as they were statistically higher in obese patients. However, there was no statistical significant difference regarding sleep efficiency.
In this study there was statistical significant difference between the studied groups (COPD and OSA) regarding Stop Bang, Ep worth, mMRC questionnaires as it was significantly higher in obese patients.
There was statistical significant difference of AHI regarding COPD severity as the index increases with increasing severity.
We found statistical significant difference of OSA prevalence regarding COPD severity as OSA increases with increasing disease severity with total prevalence of 60%.
In this study there was statistical significant difference between mild, moderate, severe (obese & non obese) COPD regarding prevalence of OSA as the prevalence increases with increasing COPD severity.
We found that in non obese COPD patients there were significant positive correlations between AHI and smoking index, stop bang score, Epworth scale and there were significant negative correlations between AHI and Pre FEV1, Pre FVC, FEV1/FVC, Post FEV1, average oxygen saturation & base line oxygen. However, in obese COPD patients there were significant positive correlations between AHI and smoking index, stop bang score, Epworth scale, mMRC, oxygen desaturation index, neck circumference and BMI and there were significant negative correlations between AHI and Pre FEV1, Pre FVC, FEV1/FVC, Post FEV1, average oxygen saturation & base line oxygen.
There was statistical significant negative correlation between average oxygen saturation and both neck circumference and BMI in all COPD patients.
Multivariate logistic regression analysis revealed that BMI, Post FEV1, smoking index and baseline oxygen were independent predictors of OSA in COPD patients with no impact of pulmonary hypertention on OSA (reflected by AHI) in COPD patients.
Conclusion