1. Overlap syndrome (chronic obstructive pulmonary disease and respiratory sleep disorders) – experience of Pulmonology Cl. Tg. Mures, Romania
Gabriela Jimborean, Dombi Istvan, Alexandra Comes, Edith Simona Ianosi
University of Medicine and Pharmacy, Pulmonology Clinic, Tg. Mures, Romania
1. Abstract
11. Interdisciplinary medical team for investigation and treatment
Pulmonology - clinic diagnosis, Chest x- ray, CT and bronchoscopy (in selected patients – upon Chest-x-ray suspicion for lung cancer or TB), 6 min. walk-test, blood gases – CPAP recommendation and monitoring, smoking cessation counseling, education
Bacteriology – for nonspecific flora (in moderate/severe COPD exacerbation) and Koch B.
ENT 100% - to rule out a local superimposed cause of OSA
Cardiology consult and Heart Ultrasound
Diabetes specialist and nutritionist - for diet prescription an DM monitoring
CPAP devices and Oxygen technician - to assure the supply and service
Physiotherapy for pulmonary rehabilitation
General practitioner – family physician
Objectives: Analysis of the clinical aspects and treatment in overlap syndrome (OS) (chronic obstructive pulmonary disease COPD and respiratory sleep disorders RSD).
Methods: 90 COPD patients (83.3% males, 85.3% smokers) were suspected having concomitant RSD after clinical examination and sleep questionnaires thereby we performed sleep respiratory polygraphy and extended consults.
Results: 91.1% from our group had RSD: obstructive sleep apnea (OSA) 90.2% (24.3% moderate, 65.7% severe) and 19.5% obesity-hypoventilation syndrome (OHS). 18.8% of OS were overweight and 73.3% obese. Age: 80.4% between yo (54.4% ˂60). Patients with OS presented severe complication/comorbidities: hypertension 63.4%, cor pulmonale 43.9%; 31.7% arrithmia; 32.9% cardiac failure; 39% dyslipidemia; 31.7% diabetes % of OS were never investigated for RSD. We performed in the second night, titration for CPAP therapy. Treatment had an interdisciplinary approach: combined bronchodilators, treatment of comorbities, pulmonary rehabilitation, tobacco/alcohol cessation, CPAP/BiPAP + O2 in remaining hypoxemic patients. 51.2% of patients had not accessibility to CPAP (lack of financial coverage by the public health system).
Conclusion: OS included clinical aspects of severity due to both COPD and RSD. Detailed medical history, sleep questionnaires are recommended for active RSD seeking in COPD. Sleep polygraphy was a cheap tool for OSA diagnosis. Adherence to CPAP is still low despite the severe OSA and the repeated educational messages.
12. Complications/comorbidities in OS patients
2. Study in 90 patients suspected to have COPD and RSD (overlap syndrome OS)
13. Thoracic CT scan in OS patients
4. Smoking in COPD patients 3.
Total smokers 76.6%
14. Duration from the initial moment of RSD suspicion and diagnosis + treatment
(using the 4-5 channels device -respiratory polygraph) ~ average 3 days
M:F=5:1
5. Suggestive signs for RSD in COPD patients
15. Treatment of OS patients
+ Combined inhaled bronchodilators
(anticholinergic + β2 adrenergic receptor
agonists)+ inhaled corticoids
- Treatment of comorbidities
- Smoking + alcohol cessation counseling
- Pulmonary rehabilitation (general
exercises, respiratory muscle exercise)
- Diet for weight loss, without salt , lipids
adapted to comorbidities
- Long time home O2 added to BiPAP
in Chronic Respiratory Failure
73.3%
6. Body weight 7.
7. Age distribution of OS patients 8.
16. Compliance to CPAP recommendation - very low % of patients without
accesibility to CPAP (lack of financial coverage by the public health system)
17. Conclusions
In our study OS included aspects of severity due to both COPD and OSA (with frequent respiratory complications - pulmonary hypertension, cor pulmonale, polyglobulia, respiratory insufficiency, cardiovascular and metabolic complications)
Active respiratory sleep disorders seeking in COPD patients is strongly recommended (by detailed medical history, sleep questionnaires, Epworth scale, respiratory polygraphy)
Patients with SAS should have recommendation for a controle for COPD by anamnesis, RFTs (especially smokers)
Smoking (active and former smoking) was met in a great percentage in our study 76.6% (much higher than the country prevalence – 26% in population over 15)
Since polysomnography is costly and not generally available, respiratory polygraphic sleep studies were used. Sleep respiratory polygraphy was a cheap, repeatable and accessible tool for OSA diagnosis in our clinic (+ early treatment - 1 night diagnosis, 1-2 night autotitration with APAP)
Adherence to CPAP/BiPAP is still low 51.2% despite the severe OSA/OHS and repeated educational messages (cause – lack of coverage by the insurances)
Smoking, alcohol cessation and maintaining a proper BMI would reduce the risk factors for both diseases (COPD and SAS) as well as CV and metabolic comorbidities
Overlap syndrome will include simultaneously combined maximal treatment for COPD and SAS to decrease symptoms, increase the quality of life and prevent further complication
Role of the multidisciplinary team is crucial in diagnosis and monitoring complex Overlap syndrome.
80.4% between yo , 54.4% ˂60 yo
9. Respiratory sleep disorders found in COPD patients
The type of RSD do not correlate with the COPD severity
10. Type of sleep apneea
10.
Obstructive
sleep apneea
2/3 severe OSA
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