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Nocturnal hypoxemia in COPD: the amplifying effect of comorbid OSA and PLMS on oxygen desaturation
Viraj Jain1, Harshill Modi2, Moon Park2
1Loyola Marymount University, Los Angeles, CA, USA.
Background:
Chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and periodic limb movements of sleep (PLMS) frequently co-occur and may exacerbate nocturnal hypoxemia. Still, their combined effects are not well defined.
Objectives:
To examine the independent and interactive effects of COPD, OSA, and PLMS on nocturnal oxygen desaturation.
Design:
Cross-sectional analysis of a sleep study cohort.
Methods:
We analyzed 711 participants (mean age 57.2 ± 17.9 years; 44.4% male), including 48 with COPD. Time with oxygen saturation ⩽88% (ST) and mean SpO2 were compared across COPD and OSA/PLMS subgroups. Multivariable regression tested the independent and interaction effects of COPD, OSA, PLMS, age, and sex.
Results:
Participants with COPD had lower mean SpO2 and longer ST than non-COPD participants (p < 0.005). ST was greatest in those with both OSA and PLMS, particularly in COPD. COPD (+46.4 min, p < 0.001) and OSA (+10.5 min, p = 0.009) independently increased ST. A negative COPD × OSA interaction (p = 0.021) indicated less-than-additive effects, whereas a positive COPD × OSA × PLMS interaction (p = 0.036) identified the highest desaturation burden.
Conclusion:
COPD and OSA independently worsen nocturnal hypoxemia, while the coexistence of COPD, OSA, and PLMS confers the greatest desaturation burden, underscoring the importance of evaluating overlapping conditions in clinical assessment.
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