Interaction of BMI and respiratory status in obstructive sleep apnea, a cross-sectional COPD study

This cross-sectional study of 136 patients with chronic obstructive pulmonary disease (COPD) investigated the mechanism underlying overlap syndrome, defined as coexisting COPD and obstructive sleep apnea (OSA). OSA was defined as a respiratory event index (REI) ≥ 5 events/h, determined using type-3 portable monitors. The mean REI was 12.8 events/h. Most participants (60.1%) had mild OSA (REI: 5-15 events/h). The REI was positively correlated with forced expiratory volume in one second (%FEV₁) (r = 0.33, p < 0.001), body mass index (BMI) (r = 0.24, p = 0.005), and fat-free mass index (r = 0.31, p = 0.005), and negatively correlated with residual volume divided by total lung capacity (r = -0.27, p = 0.003). Receiver-operating characteristic curve analysis revealed an optimal BMI cutoff of 21.96 kg/m² for predicting moderate/severe OSA. A BMI ≥ 21.96 kg/m² was associated with OSA among participants with %FEV₁ ≥ 50%, but not those with %FEV₁ < 50%. This study revealed an interaction between airflow limitation and hyperinflation, nutritional status, and OSA.