ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Lung Structure and Risk of Sleep Apnea in SPIROMICS
Session Title
TP39 - TP039 COPD COMORBIDITIES
Abstract
A2237 - Lung Structure and Risk of Sleep Apnea in SPIROMICS
Author Block: A. L. Koch1, T. L. Shing2, A. M. Namen3, D. Couper4, B. M. Smith5, R. Barr6, S. P. Bhatt7, N. Putcha8, A. P. Comellas9, A. D. Baugh10, C. B. Cooper11, I. Barjaktarevic12, R. P. Bowler13, M. K. Han14, V. Kim15, R. Paine16, M. T. Dransfield17, R. E. Kanner18, J. A. Krishnan19, F. J. Martinez20, P. Woodruff21, N. N. Hansel22, E. A. Hoffman23, S. P. Peters24, V. E. Ortega25; 1Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 2University of North Carolina, Chapel Hill, NC, United States, 3Pulmonary Critical care, Wake Forest BMC, Winston-Salem, NC, United States, 4Biostatistics, Chapel Hill, NC, United States, 5Internal Medicine, Columbia University, New York, NY, United States, 6Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States, 7Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 8Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 9Internal Medicine/Pulmonary, University of Iowa, Iowa City, IA, United States, 10Internal Medicine, University of Toledo, Toledo, OH, United States, 11Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States, 12Pulmonary and Critical Care, UCLA, Los Angeles, CA, United States, 13Natl Jewish Health, Denver, CO, United States, 14University of Michigan School of Medicine, Ann Arbor, MI, United States, 15Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States, 16Univ of Utah, Salt Lake City, UT, United States, 17Univ of Alabama Birmingham & Birmingham VA Med Ctr, Birmingham, AL, United States, 18Univ of Utah Sch of Med, Salt Lake City, UT, United States, 19Univ of Illinois, Chicago, IL, United States, 20Weill Cornell Medical College, New York, NY, United States, 21Medicine, University of California, San Francisco, San Francisco, CA, United States, 22Johns Hopkins Univ, Baltimore, MD, United States, 23Univ of Iowa Carver Coll of Med, Iowa City, IA, United States, 24Internal Medicine, Wake Forest Univ Hlth Sciences, Winston-Salem, NC, United States, 25Wake Forest School of Medicine, Winston Salem, NC, United States.
Rationale: SPIROMICS is a prospective cohort study that has enrolled 2,981 participants across four strata (Never smokers, Smokers without COPD, Mild/Moderate COPD, and Severe COPD) with the goals of identifying new COPD subgroups and intermediate markers of disease progression. Individuals with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations (Omachi 2012, Zeidler 2018). COPD severity also associates with CT scan-based emphysema and alterations in airway wall dimensions (Han 2009). We hypothesize that lung function and lung structure influence the risk of sleep apnea among current and former smokers. Methods: We calculated two OSA risk scores, the Berlin Sleep Questionnaire (BSQ, OSA high-risk cutoff ≥2 positive categories) and the DOISNORE50 (Disease[Atrial Fibrillation/stroke/hypertension], Observed apnea, Insomnia, Snoring, Neck circumference[>17inches males,>16inches females], Obesity[BMI>32], R[Are you male?], Excessive daytime sleepiness, ≥50years age) score (OSA high-risk cutoff ≥6), in 1,767 current and former smokers with available data from SPIROMICS. Regression models included age, sex, smoking status/pack-years, BMI, height, and study site.Results: The study cohort had a mean age of 63 years, BMI of 28 kg/m2, and FEV1 of 74.8% predicted. The majority were male (55%), white (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% of participants using DOISNORE50 and BSQ, respectively. There was a 9% increased odds of a high-risk DOISNORE50 score (OR=1.09, 95%CI:1.03-1.14) and a nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1% predicted (OR=1.04, 95%CI:0.998-1.09). Individuals with a high-risk of OSA based on DOISNORE50 had higher CT-based measures of functional small airways disease (PRM-fSAD, OR=1.10, 95%CI:1.02-1.20, p=0.02), mean segmental % wall area (OR=1.06, 95%CI:1.01-1.11, p=0.02), tracheal % wall area (T%WA, OR=1.05, 95%CI:1.01-1.10, p=0.01), and lower measures of dysanapsis (OR0.85 95%CI:0.74-0.98, p=0.02), but only T%WA associated with a high-risk BSQ score (OR=1.05, 95%CI:1.01-1.06, p=0.007). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air-trapping, PRM-fSAD, mean segmental wall area, tracheal % wall area, dysanapsis) for DOISNORE50 (OR=1.12, 95%CI: 1.03-1.22) and BSQ (OR=1.09, 95%CI: 1.01-1.18). Conclusion: We confirm that lower lung function independently associates with having a high-risk for OSA based on the DOISNORE50 score in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal % wall area had strong effects on OSA risk, but did not completely mediate the association between lung function and OSA risk.
Author Block: A. L. Koch1, T. L. Shing2, A. M. Namen3, D. Couper4, B. M. Smith5, R. Barr6, S. P. Bhatt7, N. Putcha8, A. P. Comellas9, A. D. Baugh10, C. B. Cooper11, I. Barjaktarevic12, R. P. Bowler13, M. K. Han14, V. Kim15, R. Paine16, M. T. Dransfield17, R. E. Kanner18, J. A. Krishnan19, F. J. Martinez20, P. Woodruff21, N. N. Hansel22, E. A. Hoffman23, S. P. Peters24, V. E. Ortega25; 1Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 2University of North Carolina, Chapel Hill, NC, United States, 3Pulmonary Critical care, Wake Forest BMC, Winston-Salem, NC, United States, 4Biostatistics, Chapel Hill, NC, United States, 5Internal Medicine, Columbia University, New York, NY, United States, 6Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States, 7Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 8Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 9Internal Medicine/Pulmonary, University of Iowa, Iowa City, IA, United States, 10Internal Medicine, University of Toledo, Toledo, OH, United States, 11Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States, 12Pulmonary and Critical Care, UCLA, Los Angeles, CA, United States, 13Natl Jewish Health, Denver, CO, United States, 14University of Michigan School of Medicine, Ann Arbor, MI, United States, 15Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States, 16Univ of Utah, Salt Lake City, UT, United States, 17Univ of Alabama Birmingham & Birmingham VA Med Ctr, Birmingham, AL, United States, 18Univ of Utah Sch of Med, Salt Lake City, UT, United States, 19Univ of Illinois, Chicago, IL, United States, 20Weill Cornell Medical College, New York, NY, United States, 21Medicine, University of California, San Francisco, San Francisco, CA, United States, 22Johns Hopkins Univ, Baltimore, MD, United States, 23Univ of Iowa Carver Coll of Med, Iowa City, IA, United States, 24Internal Medicine, Wake Forest Univ Hlth Sciences, Winston-Salem, NC, United States, 25Wake Forest School of Medicine, Winston Salem, NC, United States.
Rationale: SPIROMICS is a prospective cohort study that has enrolled 2,981 participants across four strata (Never smokers, Smokers without COPD, Mild/Moderate COPD, and Severe COPD) with the goals of identifying new COPD subgroups and intermediate markers of disease progression. Individuals with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations (Omachi 2012, Zeidler 2018). COPD severity also associates with CT scan-based emphysema and alterations in airway wall dimensions (Han 2009). We hypothesize that lung function and lung structure influence the risk of sleep apnea among current and former smokers. Methods: We calculated two OSA risk scores, the Berlin Sleep Questionnaire (BSQ, OSA high-risk cutoff ≥2 positive categories) and the DOISNORE50 (Disease[Atrial Fibrillation/stroke/hypertension], Observed apnea, Insomnia, Snoring, Neck circumference[>17inches males,>16inches females], Obesity[BMI>32], R[Are you male?], Excessive daytime sleepiness, ≥50years age) score (OSA high-risk cutoff ≥6), in 1,767 current and former smokers with available data from SPIROMICS. Regression models included age, sex, smoking status/pack-years, BMI, height, and study site.Results: The study cohort had a mean age of 63 years, BMI of 28 kg/m2, and FEV1 of 74.8% predicted. The majority were male (55%), white (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% of participants using DOISNORE50 and BSQ, respectively. There was a 9% increased odds of a high-risk DOISNORE50 score (OR=1.09, 95%CI:1.03-1.14) and a nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1% predicted (OR=1.04, 95%CI:0.998-1.09). Individuals with a high-risk of OSA based on DOISNORE50 had higher CT-based measures of functional small airways disease (PRM-fSAD, OR=1.10, 95%CI:1.02-1.20, p=0.02), mean segmental % wall area (OR=1.06, 95%CI:1.01-1.11, p=0.02), tracheal % wall area (T%WA, OR=1.05, 95%CI:1.01-1.10, p=0.01), and lower measures of dysanapsis (OR0.85 95%CI:0.74-0.98, p=0.02), but only T%WA associated with a high-risk BSQ score (OR=1.05, 95%CI:1.01-1.06, p=0.007). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air-trapping, PRM-fSAD, mean segmental wall area, tracheal % wall area, dysanapsis) for DOISNORE50 (OR=1.12, 95%CI: 1.03-1.22) and BSQ (OR=1.09, 95%CI: 1.01-1.18). Conclusion: We confirm that lower lung function independently associates with having a high-risk for OSA based on the DOISNORE50 score in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal % wall area had strong effects on OSA risk, but did not completely mediate the association between lung function and OSA risk.
