Obstructive sleep apnea (OSA) diagnosis in chronic obstructive pulmonary disease (COPD) patients is an ignored comorbidity. While excessive daytime sleepiness (EDS) patients are diagnosed and treated early, delayed diagnosis in non-EDS patients may lead to adverse outcomes, especially in the form of cardiovascular events. The conventional questionnaires make use of EDS and thus become nugatory in non-EDS patients. Submental ultrasound has proven beneficial for screening for OSA as well as directing its management and monitoring of treatment.
Gray EL, McKenzie DK, Eckert DJ. Obstructive sleep apnoea without obesity is common and difficult to treat: Evidence for a distinct pathophysiological phenotype. J Clin Sleep Med 2017;13(1):81–88. DOI: 10.5664/jcsm.6394.
Agustí A, Celli BR, Criner GJ, et al. Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. Am J Respir Crit Care Med 2023;207(7):819–837. DOI: 10.1164/rccm.202301-0106PP.
Archontogeorgis K, Voulgaris A, Papanas N, et al. Metabolic syndrome in patients with coexistent obstructive sleep apnea syndrome and chronic obstructive pulmonary disease (overlap syndrome). Metab Syndr Relat Disord 2020;18(6):296–301. DOI: 10.1089/met.2019.0126.
Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000;118(2):372–379. DOI: 10.1378/chest.118.2.372.
Liao LJ, Cho TY, Cheng PW, et al. Submental ultrasonography in diagnosing severe obstructive sleep apnea syndrome. Journal of Medical Ultrasound 2016;24(3):107–111. DOI: https://doi.org/10.1016/j.jmu.2016.06.002.
Shu CC, Lee P, Lin JW, et al. The use of sub-mental ultrasonography for identifying patients with severe obstructive sleep apnea. PLoS One 2013;8(5):e62848. DOI: 10.1371/journal.pone.0062848.
Singh M, Tuteja A, Wong DT, et al. Point-of-Care ultrasound for obstructive sleep apnea screening: Are we there yet? A systematic review and meta-analysis. Anesth Analg 2019;129(6):1673–1691. DOI: 10.1213/ANE.0000000000004350.
McNicholas WT, Hansson D, Schiza S, et al. Sleep in chronic respiratory disease: COPD and hypoventilation disorders. Eur Respir Rev 2019;28:190064. DOI: 10.1183/16000617.0064-2019.
Yokoba M, Hawes HG, Kieser TM, et al. Parasternal intercostal and diaphragm function during sleep. J Appl Physiol (1985) 2016;121(1):59–65. DOI: 10.1152/japplphysiol.00508.2015.
Owens RL, Malhotra A. Sleep-disordered breathing and COPD: The overlap syndrome. Respir Care 2010;55(10):1333–1344; discussion 1344–1346. PMID: 20875160.
Lacasse Y, Sériès F, Vujovic-Zotovic N, et al. Evaluating nocturnal oxygen desaturation in COPD–revised. Respir Med 2011;105(9): 1331–1337. DOI: 10.1016/j.rmed.2011.04.003.
Singh S, Kaur H, Singh S, et al. The Overlap Syndrome. Cureus 2018;10(10):e3453. DOI: 10.7759/cureus.3453.
Mohammad OI, Elgazzar AG, Mahfouz SM, et al. Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease. Egypt J Bronchol 2021;15:46. DOI: https://doi.org/10.1186/s43168-021-00093-8.
Gunduz C, Basoglu OK, Tasbakan MS. Prevalence of overlap syndrome in chronic obstructive pulmonary disease patients without sleep apnea symptoms. Clin Respir J 2018;12(1):105–112. DOI: 10.1111/crj.12493.
Venkateswaran S, Tee A. Overlap syndrome between chronic obstructive pulmonary disease and obstructive sleep apnoea in a Southeast Asian teaching hospital. Singapore Med J 2014;55(9): 488–492. DOI: 10.11622/smedj.2014117.
Marin JM, Soriano JB, Carrizo SJ, et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: The overlap syndrome. Am J Respir Crit Care Med 2010;182(3):325–331. DOI: 10.1164/rccm.200912-1869OC.
Mengqing X, Weihua H, Minglin D, et al. The screening value of ESS, SACS, BQ, and SBQ on obstructive sleep apnea in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019;14:2497–2505. DOI: 10.2147/COPD.S223354.
Pissulin FDM, Pacagnelli FL, Aldá MA, et al. The triad of obstructive sleep apnea syndrome, COPD, and obesity: Sensitivity of sleep scales and respiratory questionnaires. J Bras Pneumol 2018;44(3):202–206. DOI: 10.1590/S1806-37562016000000308.
Schwab RJ, Kim C, Bagchi S, et al. Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents. Am J Respir Crit Care Med Med 2015;191(11):1295–1309. DOI: 10.1164/rccm.201501-0169OC.
Hussein SA, Kamel KM, Kaddah SZ, et al. Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea. Adv Respir Med 2020;88(6):548–557. DOI: 10.5603/ARM.a2020.0187.
