Athanasios Voulgaris1,2, Kostas Archontogeorgis1, Nikolaos Papanas3, Eleni Pilitsi2, Evangelia Nena4, Maria Xanthoudaki2, Dimitri P Mikhailidis5, Marios E Froudarakis2, Paschalis Steiropoulos1,2. 1. MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 2. Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 3. Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 4. Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 5. Department of Clinical Biochemistry, Royal Free Hospital, University College London, London, United Kingdom.
Abstract
INTRODUCTION: Accumulating evidence suggests that cardiovascular disease (CVD) is highly prevalent among patients with concurrent obstructive sleep apnoea syndrome (OSAS) and chronic obstructive pulmonary disease, otherwise known as overlap syndrome (OS). OBJECTIVES: The aim of this study was to investigate the 10-year risk for CVD in OS patients compared with OSAS patients and controls. METHODS: Consecutive patients, referred for symptoms suggestive of OSAS, were evaluated with polysomnography and pulmonary function testing. Cardiovascular risk was assessed using the Framingham risk score (FRS) and systematic coronary risk evaluation (SCORE). RESULTS: Overall, 244 participants (184 males) without CVD and diabetes were divided into 3 groups: controls (n = 63), OSAS (n = 139) and OS (n = 42). Both FRS and SCORE were found to be elevated in the OS group compared with the OSAS and control groups (P < .001 for all). In multivariate analysis, age (β = .461, P < .001), forced expiratory volume in first second (β = -.285, P = .036) and oxygen desaturation index (ODI) (β = .234, P = .007) were major determinants for the SCORE, whereas age (β = .308, P < .001) and apnoea-hypopnoea index (β = .252, P = .010) for the FRS. CONCLUSION: In our study, an increased risk for CVD was observed in a group of patients with OS at the time of their initial evaluation. Further studies are needed in the field of OS in order to investigate, prevent and manage early CVD in this population.
INTRODUCTION: Accumulating evidence suggests that cardiovascular disease (CVD) is highly prevalent among patients with concurrent obstructive sleep apnoea syndrome (OSAS) and chronic obstructive pulmonary disease, otherwise known as overlap syndrome (OS). OBJECTIVES: The aim of this study was to investigate the 10-year risk for CVD in OS patients compared with OSAS patients and controls. METHODS: Consecutive patients, referred for symptoms suggestive of OSAS, were evaluated with polysomnography and pulmonary function testing. Cardiovascular risk was assessed using the Framingham risk score (FRS) and systematic coronary risk evaluation (SCORE). RESULTS: Overall, 244 participants (184 males) without CVD and diabetes were divided into 3 groups: controls (n = 63), OSAS (n = 139) and OS (n = 42). Both FRS and SCORE were found to be elevated in the OS group compared with the OSAS and control groups (P < .001 for all). In multivariate analysis, age (β = .461, P < .001), forced expiratory volume in first second (β = -.285, P = .036) and oxygen desaturation index (ODI) (β = .234, P = .007) were major determinants for the SCORE, whereas age (β = .308, P < .001) and apnoea-hypopnoea index (β = .252, P = .010) for the FRS. CONCLUSION: In our study, an increased risk for CVD was observed in a group of patients with OS at the time of their initial evaluation. Further studies are needed in the field of OS in order to investigate, prevent and manage early CVD in this population.