Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients
Little is known about the distribution of etiology in obstructive sleep apnea (OSA) combined with chronic breathlessness. A significant portion of patients in this group have so-called “overlap syndrome (OVS)”, characterized by chronic obstructive pulmonary disease (COPD). OVS has more complications...
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/3/936 |
| _version_ | 1797624186161594368 |
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| author | Dan Liu Zhiding Wang Yan Zhuang Yan Wang Jing Zhang Rui Wang Jie Cao Jing Feng |
| author_facet | Dan Liu Zhiding Wang Yan Zhuang Yan Wang Jing Zhang Rui Wang Jie Cao Jing Feng |
| author_sort | Dan Liu |
| collection | DOAJ |
| description | Little is known about the distribution of etiology in obstructive sleep apnea (OSA) combined with chronic breathlessness. A significant portion of patients in this group have so-called “overlap syndrome (OVS)”, characterized by chronic obstructive pulmonary disease (COPD). OVS has more complications and a poorer prognosis compared to patients with either OSA or COPD alone, which makes it important to identify OVS early in OSA. The current study was a retrospective cross-sectional analysis of consecutive adult patients who were diagnosed with OSA (<i>n</i> = 1062), of whom 275 were hospitalized due to chronic breathlessness. Respiratory and cardiac diseases accounted for the vast majority of causes, followed by gastrointestinal and renal disorders. The final study population comprised 115 patients with OSA alone (<i>n</i> = 64) and OVS (<i>n</i> = 51), who had chronic breathlessness as the primary complaint, not secondary as one of many other complaints. Lymphocytes, CD4 counts, neutrophil-to-lymphocyte ratio (NLR), and PLR were differently expressed between the OSA-alone group and OVS group. The NLR, lymphocytes, and CD4 counts had a moderate diagnostic value for OVS in OSA patients, with AUCs of 0.708 (95% CI, 0.614–0.802), 0.719 (95% CI, 0.624–0.813), and 0.744 (95% CI, 0.653–0.834), respectively. The NLR had the highest AUC for predicting a 6-month re-admission of OVS, with a cut-off of 3.567 and a moderate prognostic value. The sensitivity and specificity were 0.8 and 0.732, respectively. In the animal model, the spleen hematoxylin- and eosin-stained, electron microscopy images showed germinal-center damage, chromatin activation, and mitochondrial swelling under the overlapping effect of intermittent hypoxia and cigarette smoke exposure. OSA with chronic breathlessness cannot be overstated. A significant proportion of patients with COPD in this group had poor lung function at initial diagnosis. The NLR is a useful biomarker to differentiate OVS among OSA patients combined with chronic breathlessness. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T09:39:27Z |
| publishDate | 2023-01-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-f94f47109a204dc48c84a885fdf837712023-11-16T17:09:20ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112393610.3390/jcm12030936Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among PatientsDan Liu0Zhiding Wang1Yan Zhuang2Yan Wang3Jing Zhang4Rui Wang5Jie Cao6Jing Feng7Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaBeijing Institute of Basic Medical Sciences, Beijing 100850, ChinaDepartment of Respiratory Medicine, Tianjin Medical University Second Hospital, Tianjin 300052, ChinaDepartment of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaDepartment of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaDepartment of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaDepartment of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaDepartment of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, ChinaLittle is known about the distribution of etiology in obstructive sleep apnea (OSA) combined with chronic breathlessness. A significant portion of patients in this group have so-called “overlap syndrome (OVS)”, characterized by chronic obstructive pulmonary disease (COPD). OVS has more complications and a poorer prognosis compared to patients with either OSA or COPD alone, which makes it important to identify OVS early in OSA. The current study was a retrospective cross-sectional analysis of consecutive adult patients who were diagnosed with OSA (<i>n</i> = 1062), of whom 275 were hospitalized due to chronic breathlessness. Respiratory and cardiac diseases accounted for the vast majority of causes, followed by gastrointestinal and renal disorders. The final study population comprised 115 patients with OSA alone (<i>n</i> = 64) and OVS (<i>n</i> = 51), who had chronic breathlessness as the primary complaint, not secondary as one of many other complaints. Lymphocytes, CD4 counts, neutrophil-to-lymphocyte ratio (NLR), and PLR were differently expressed between the OSA-alone group and OVS group. The NLR, lymphocytes, and CD4 counts had a moderate diagnostic value for OVS in OSA patients, with AUCs of 0.708 (95% CI, 0.614–0.802), 0.719 (95% CI, 0.624–0.813), and 0.744 (95% CI, 0.653–0.834), respectively. The NLR had the highest AUC for predicting a 6-month re-admission of OVS, with a cut-off of 3.567 and a moderate prognostic value. The sensitivity and specificity were 0.8 and 0.732, respectively. In the animal model, the spleen hematoxylin- and eosin-stained, electron microscopy images showed germinal-center damage, chromatin activation, and mitochondrial swelling under the overlapping effect of intermittent hypoxia and cigarette smoke exposure. OSA with chronic breathlessness cannot be overstated. A significant proportion of patients with COPD in this group had poor lung function at initial diagnosis. The NLR is a useful biomarker to differentiate OVS among OSA patients combined with chronic breathlessness.https://www.mdpi.com/2077-0383/12/3/936OSAbreathlessnessOVSlymphocytesintermittent hypoxia |
| spellingShingle | Dan Liu Zhiding Wang Yan Zhuang Yan Wang Jing Zhang Rui Wang Jie Cao Jing Feng Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients Journal of Clinical Medicine OSA breathlessness OVS lymphocytes intermittent hypoxia |
| title | Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients |
| title_full | Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients |
| title_fullStr | Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients |
| title_full_unstemmed | Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients |
| title_short | Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients |
| title_sort | chronic breathlessness in obstructive sleep apnea and the use of lymphocyte parameters to identify overlap syndrome among patients |
| topic | OSA breathlessness OVS lymphocytes intermittent hypoxia |
| url | https://www.mdpi.com/2077-0383/12/3/936 |
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