Comorbidities in Patients With Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilitation Outcomes.

PURPOSE: The objective of this study was to evaluate the impact of comorbidities as potential predictors of the response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). METHODS: The study included 165 patients with COPD with exercise limitations. Comorbidity was classified as cardiac, metabolic, orthopedic, behavioral health problems, or other diseases. Number of comorbidities was grouped as 0, 1, or ≥2. Outcomes were defined as improvement in exercise capacity (maximal exercise capacity, 6-minute walk test, and constant workload cycle exercise duration) and quality of life (Chronic Respiratory Questionnaire). We assessed the effect of comorbidities on improvement in outcomes and the impact of the number of comorbidities on the percentage of patients reaching the minimal clinically important difference for each outcome. RESULTS: Most patients (n = 160; 96%) were elderly males (mean age 70 years) with COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II to IV. Sixty-four percent of patients had at least 1 comorbidity. The ≥2 comorbidity group (n = 29) had a higher modified Charlson index and more patients required continuous supplemental oxygen. Absolute differences in dyspnea scores in patients with cardiac disease and orthopedic problems compared with those without these comorbidities were 2.6 ± 0.87; 95% CI 0.89 to 4.32; p = .003, and -3.25 ± 1.23; 95% CI -5.69 to -0.82; p = .009, respectively. Comorbidities had no significant effect on other exercise outcomes or quality of life. CONCLUSION: Patients with cardiac disease experienced greater improvement in the dyspnea score compared with patients with no cardiac disease, whereas patients with orthopedic problems had a smaller but also clinically significant improvement in dyspnea after pulmonary rehabilitation.

Postoperative complications in obstructive sleep apnea.

STUDY OBJECTIVES: This study was conducted to determine whether postoperative complications are increased in patients with obstructive sleep apnea (OSA) and to study the impact of the severity of OSA and preoperative use of continuous positive airway pressure (CPAP) on the postoperative outcome. DESIGN AND SETTING: This study is retrospective in nature and was undertaken at the VA Medical Center. PARTICIPANTS AND METHODS: Three hundred seventy patients who had undergone both a major surgical procedure and a sleep study from 2000 to 2010 were identified. Patients were divided into four groups: OSA negative (apnea-hypopnea index (AHI) < 5/h), OSA positive; mild: AHI 5 to <15/h; moderate: AHI 15 to <30/h; and severe: AHI ≥ 30/h. No intervention was made during the course of the study. Postoperative complications namely respiratory, cardiac, neurological, and unplanned intensive care unit transfers were collected. RESULTS: There were 284 (76.8 %) patients having OSA and 86 (23.2 %) without OSA. The overall incidence of total complications was significantly higher in the OSA patients compared with the control patients (48.9 vs. 31.4 %; odds ratio 2.09, 95 % CI 1.25-3.49). There was no significant difference in total complications between those using and not using CPAP prior to hospitalization. Patients with sleep apnea had a higher incidence of respiratory complications compared to patients without sleep apnea (40.4 vs. 23.2 %; odds ratio 2.24, 95 % CI 1.29-3.90). There was no significant difference in major cardiac complications in the OSA patients compared with the control patients (13.0 vs. 9.3 %; odds ratio 1.46, 95 % CI 0.65-3.26). CONCLUSION: OSA is associated with a significantly increased rate of postoperative complications.

Does sleep apnea increase the risk of cardiorespiratory complications during endoscopy procedures?

BACKGROUND: Patients with obstructive sleep apnea (OSA) have an increased risk of perioperative complications. AIM: The purpose of this study is to assess whether OSA increases the risk of cardiorespiratory complications in patients undergoing endoscopic procedures. METHODS: A retrospective study was performed. We identified all patients who had undergone both an endoscopic procedure under conscious sedation and a sleep study from January 2001 to May 2008. Patients were divided into four groups: OSA negative (apnea-hypopnea index (AHI) < 5/h), OSA positive; mild: AHI 5-15/h, moderate: AHI 15.1-30/h, and severe: AHI > 30/h. Minor and major complications were identified. The minor ones were hypertension, hypotension, bradycardia, tachycardia, oxygen desaturation (<90%), and bradypnea. Major complications included chest pain, respiratory distress, cardiorespiratory arrest, or any minor complication that required intervention. RESULTS: Procedures were performed in 639 patients: colonoscopies 68.5%, upper endoscopies 20.2%, and combined procedures 11.3%. The mean age was 60.5 years, mean body mass index 33.7, and 93% were males. Sleep study results: 130 negative, 509 positive; 135 mild, 125 moderate, and 249 severe. Of the patients, 19% had minor complications, while 7% had major complications. There was no significant difference between the patients with and without OSA in the rate of minor complications (odds ratio 1.17, 95% confidence interval 0.70-1.92) or major complications (odds ratio 1.19, 95% confidence interval 0.54-2.63). The odds ratio was also not significantly increased when a cutoff value of 10 or 15/h was used to delineate a positive sleep study. CONCLUSION: For patients undergoing endoscopy procedures under conscious sedation, the presence of OSA does not clearly increase the risk of cardiorespiratory complications.