Obstructive Sleep Apnea Clinical Trial
Official title:
Pathophysiology of the Upper Airway in Patients With Chronic Obstructive Pulmonary Disease (COPD) and Concomitant Obstructive Sleep Apnea (OSA)
The purpose of study is to evaluate the physiologic effects of pulmonary tissue/structural
changes associated with COPD and upper airway inflammation on upper airway collapsibility.
Upper airway collapsibility is closely associated with development of obstructive sleep apnea
(OSA), which is a common disease characterized by repetitive collapse of upper airway during
sleep, leading to hypoxemia and arousal. OSA has important neurocognitive and cardiovascular
consequences, especially in patients with COPD.
Participants in this research study will undergo two overnight sleep studies (PSGs),
pulmonary function test, and CT scan of the upper airway and chest. The first sleep study
will evaluate the sleep breathing disorder and the second sleep study will measure the upper
airway collapsibility, called critical closing pressure (Pcrit). Pcrit is measured by a
modified continuous positive airway pressure (CPAP) machine which can provide a wide range of
pressures between 20 and -20 cmH2O in order to modify upper airway pressure.
This is a physiologic study to assess the effects of lower airway and lung tissue changes of
COPD on upper airway collapsibility. Increased in lung volume and destruction of alveolar
wall in COPD may have opposite and various effects on the upper airway collapsibility, which
is an important factor of OSA development.
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are very
common disorders associated with considerable morbidity, mortality, and healthcare costs. The
prevalence of both co-existing conditions is estimated to be ~4% of the general population.
This COPD-OSA "overlap" syndrome causes more severe hypoxemia than either COPD or OSA alone
and has important clinical consequences, including death. COPD is usually excluded in OSA
research and OSA is typically excluded or not assessed in studies of COPD; thus, available
information about the "overlap" syndrome is limited. Therefore, it is important to identify
patients with both COPD and OSA and determine the mechanisms of poor outcomes for these
patients in order to optimize therapy. The pathophysiology of the COPD-OSA syndrome is not
well understood. The investigators propose to investigate upper airway (UA) anatomic
characteristics and collapsibility as potential underlying mechanisms that may help to
explain the negative additive effect of having both conditions. The objectives are to study
CT measures of airway anatomy and the critical closing pressure of the upper airway (Pcrit),
a gold standard measure of upper airway collapsibility, in patients with COPD-OSA compared
with COPD only and normal controls. CT scan of upper airway and chest will allow precise
measures of upper airway characteristics and COPD associated alveolar and lower airway ch.
angesMeasures of upper airway collapsibility will provide us information about the mechanical
nature of the airway and if the patients are more likely to have OSA. Subjects with COPD-OSA
may exhibit more upper airway inflammation possibly due to their pre-existing COPD disease
and the reoccurring opening and closing of the upper airway due to the OSA. Therefore the
investigators would like to assess the degree of inflammation in these patients compared to
normal controls.
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