American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 7-14, (2003)
© 2003 American Thoracic Society
Sleep and Sleep-disordered Breathing in Adults with Predominantly Mild Obstructive Airway Disease
Mark H. Sanders,
Anne B. Newman,
Catherine L. Haggerty,
Susan Redline,
Michael Lebowitz,
Jonathan Samet,
George T. O'Connor,
Naresh M. Punjabi and
Eyal Shahar for the Sleep Heart Health Study
Divisions of Pulmonary, Allergy, and Critical Care Medicine and Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio; Department of Epidemiology and Biostatistics, and Department of Medicine Pulmonary Section, University of Arizona, Tucson, Arizona; Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Department of Medicine, Boston University, Boston, Massachusetts
Correspondence and requests for reprints should be addressed to Mark H. Sanders, M.D., Division of Pulmonary, Allergy, and Critical Care Medicine, Montefiore University Hospital, University of Pittsburgh School of Medicine, North-1292, Pittsburgh, PA 15213. E-mail: sandersmh{at}msx.upmc.edu
Neither the association between obstructive airways disease (OAD) and sleep apnea–hypopnea (SAH) nor the sleep consequences of each disorder alone and together have been characterized in an adult community setting. Our primary aims were (1) to determine if there is an association between OAD and SAH and (2) identify predictors of oxyhemoglobin desaturation during sleep in persons having OAD with and without SAH. Polysomnography and spirometry results from 5,954 participants in the Sleep Heart Health Study were analyzed. OAD was defined by a FEV1/FVC value less than 70%. Assessment of SAH prevalence in OAD was performed using thresholds of respiratory disturbance index (RDI) greater than 10 and greater than 15. A total of 1,132 participants had OAD that was predominantly mild (FEV1/FVC 63.81 ± 6.56%, mean ± SD). SAH was not more prevalent in participants with OAD than in those without OAD (22.32 versus 28.86%, with and without OAD, respectively, at RDI threshold values greater than 10; and 13.97 versus 18.63%, with and without OAD, respectively, at RDI threshold value greater than 15). In the absence of SAH, the adjusted odds ratio for sleep desaturation (> 5% total sleep time with saturation < 90%) was greater than 1.9 when FEV1/FVC was less than 65%. Participants with both OAD and SAH had greater sleep perturbation and desaturation than those with one disorder. Generally mild OAD alone was associated with minimally altered sleep quality. We conclude that (1) there is no association between generally mild OAD and SAH; (2) exclusive of SAH and after adjusting for demographic factors and awake oxyhemoglobin saturation, an FEV1/FVC value less than 65% is associated with increased risk of sleep desaturation; (3) desaturation is greater in persons with both OAD and SAH compared with each of these alone; and (4) individuals with generally mild OAD and without SAH in the community have minimally perturbed sleep.
Key Words: sleep • chronic obstructive pulmonary disease • sleep apnea • sleep disorders • sleep-disordered breathing
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Copyright © 2003 American Thoracic Society
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