Correlation between associating factors of obstructive airway disease with obstructive sleep apnoea

Samta ., H. V. Surynarayana, H. B. Chandrashekhar, Prasad H. L.


Background: Several researchers reported that OSA may contribute to asthma symptoms and severity. But, the relation between associating factors of obstructive airway disease with obstructive sleep apnoea was not well documented. Therefore, the present study has been undertaken to investigate the relation between associating factors of OAD with obstructive sleep apnoea.

Methods: Pulmonary Function Test was done for assessing air flows and measuring absolute and predicted values of FEV1, FVC, FEV1/FVC and MMEF. PFT was interpreted as normal if FEV1/FVC >70 as per GOLD and >75 as per GINA, with normal FEV1 and normal FVC. Decreased FEV1, Decreased FVC, Decreased FEV1/ FVC, predicted (<70 as per GOLD and <75 as per GINA was considered obstructive disorder.  FEV1 used to follow severity in COPD. Decreased FEV1, Decreased FVC, FEV1/FVC normal or increased was considered restrictive disorder. The data were represented as percentages and mean + SD.  Chi-square test and student‘t’ test was used to determine the statistical difference and a “p” value of less than 0.05 was considered the level of significance.

Results: The sleep efficiency, oxygen saturation, mean heart rate, arousal index and  respiratory distress index in the OAD group and in the No OAD group was found to be statistically not significant (p>0.05). The Sleep Stages in the study group (OAD and No OAD group) was also statistically insignificant except for Stage III. The PFT-FEV1was found to be statistically significant (p=0.043) when compared between OAD group and in the No OAD group.

Conclusions: Due to the consequences of the overlap syndrome, it is recommended to actively search for existence of OSA, and to treat it with continuous positive airway pressure (CPAP) concurrently with oxygen and optimal pharmacological treatment.


Polysomnography, Obstructive sleep apnoea, MMRC Dyspnea scale, Obstructive airway diseases

Full Text:



Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217-39.

Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI. Fishman’s Pulmonary Diseases and Disorders, Fourth edition; 2008.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) Updated in 2013.

Nadel JA, Widdicombe JG. Reflex effects of upper airway irritation on total lung resistance and blood pressure. J.Appl. Physiol. 1962;17:861-5.

McNicholas WT, Calverley PMA, Lee A, Edwards JC. Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD. Eur Respir J. 2004;23:825-31.

Flenley DC. Sleep in chronic obstructive lung disease. DC Clin Chest Med. 1985;6(4):651-61.

Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela- Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608-11.

Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea – pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2008;5:185-92.

Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med. 2003;167(1):7-14.

Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165:677-82.

Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676-83.

Alharbi M, Almutairi A, Alotaibi D, Alotaibi A, Shaikh S, Bahammam AS. The prevalence of asthma in patients with obstructive sleep apnoea. Prim Care Respir J. 2009;18(4):328-30.

Marin JM, Soriano JB, Carrizo SJ, Boldova A. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182(3):325-31.

Kwang M, Park SC, Chang YS, kim YS, Kim SK, Kim HJ, et al. Associations of moderate to severe Asthma with Obstructive Sleep Apnea.Younsei Med J. 2013;54(4):942-8.

Chaouat A, Weitzenblum E, Krieger J, T ifoundza, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am J Respir Crit Care Med. 1995;151(1):82-6.

Chaouat A, Weitzenblum E, Kessler R, Charpentier C, Enhart M, Schott R, et al. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients. Eur Respir J. 1999;14(5):1002-8.

Ziherl K, Sarc I, Kosnik M, Flezar M, Gabrijelcic J. Role of diffuse airway obstruction in the hypercapnia of obstructive sleep apnea. Am Rev Respir Dis. 1986;134(5):920-4.

Greenberg-Dotan S, Reuveni H, Tal A, Oksenberg A, Cohen A, Shaya FT, et al. Increased prevalence of obstructive lung disease in patients with obstructive sleep apnea. Pneumonol Alergol Pol. 2011;79(2);99-108.

Resta O, Barbaro MPF, Brindicci C, Nocerino MC, Caratozzolo G, Carbonara M. Hypercapnia in Overlap Syndrome: Possible Determinant Factors. Sleep and Breathing. 2002;6(1):11-7.

Vanesa CZ, Paz G, Morete E, Matías FDC. Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences. International Journal of COPD. 2008;3(4):112-6.

Brien O, Whitman K. Lack of benefit of continuous positive airway pressure on lung function in patients with overlap syndrome. Lung. 2005;183(6):389-404.

Rizzi M, Palma P, Andreoli A, Greco M, Bamberga M, Antivalle M, Sergi M. Prevalence and clinical feature of the "overlap syndrome", obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), in OSA population. Sleep Breath. 1997;2(3):68-72.