Lung Structure and Risk of Sleep Apnea in SPIROMICS

Abigail L Koch; Tracie L Shing; Andrew Namen; David Couper; Benjamin Smith; R Graham Barr; Surya Bhatt; Nirupama Putcha; Aaron Baugh; Amit K Saha; Michelle Ziedler; Alejandro Comellas; Christopher B Cooper; Igor Barjaktarevic; Russell P Bowler; Meilan K Han; Victor Kim; Robert Paine 3rd; Richard E Kanner; Jerry A Krishnan; Fernando J Martinez; Prescott G Woodruff; Nadia N Hansel; Eric A Hoffman; Stephen P Peters; Victor E Ortega; SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators

doi:10.15326/jcopdf.2023.0411

Lung Structure and Risk of Sleep Apnea in SPIROMICS

Chronic Obstr Pulm Dis. 2024 Jan 25;11(1):26-36. doi: 10.15326/jcopdf.2023.0411.

Authors

Abigail L Koch¹, Tracie L Shing², Andrew Namen³, David Couper², Benjamin Smith⁴, R Graham Barr⁴, Surya Bhatt⁵, Nirupama Putcha⁶, Aaron Baugh⁷, Amit K Saha³, Michelle Ziedler⁸, Alejandro Comellas⁹, Christopher B Cooper⁸, Igor Barjaktarevic⁸, Russell P Bowler¹⁰, Meilan K Han¹¹, Victor Kim¹², Robert Paine 3rd¹³, Richard E Kanner¹³, Jerry A Krishnan¹⁴, Fernando J Martinez¹⁵, Prescott G Woodruff⁷, Nadia N Hansel⁶, Eric A Hoffman⁹, Stephen P Peters³, Victor E Ortega¹⁶; SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators

Affiliations

¹ Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States.
² Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States.
³ Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States.
⁴ Department of Medicine, Columbia University Medical Center, New York, New York, United States.
⁵ Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
⁶ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States.
⁹ Departments of Radiology, Medicine and Bioengineering, University of Iowa, Iowa City, Iowa, United States.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States.
¹¹ Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States.
¹² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States.
¹³ Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States.
¹⁴ Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States.
¹⁵ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States.
¹⁶ Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States.

Abstract

Rationale: The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions.

Objectives: The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers.

Methods: Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk.

Measurements and main results: The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18).

Conclusions: Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.

Keywords: COPD; CT-scan measurements; DOISNORE50; lung function.

Abstract

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