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Volume 15 No. 01
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Accepted Papers

Scientific Investigations

Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort

Lucas M. Donovan, MD, MS1,2; Laura C. Feemster, MD, MS1,2; Edmunds M. Udris, MPH1; Matthew F. Griffith, MD1,2; Laura J. Spece, MD, MS1,2; Brian N. Palen, MD1,2; Ken He, MD1,2; Sairam Parthasarathy, MD3; Kingman P. Strohl, MD4; Vishesh K. Kapur, MD, MPH1,2; David H. Au, MD, MS1,2
1Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; 2Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; 3Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona, Tucson, Arizona; 4Section of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio

Study Objectives:

Evaluate consequences of intermediate to high risk of undiagnosed obstructive sleep apnea (OSA) among individuals with chronic obstructive pulmonary disease (COPD).


Using data from the Long Term Oxygen Treatment Trial (LOTT), we assessed OSA risk at study entry among patients with COPD. We compared outcomes among those at intermediate to high risk (modified STOP-BANG score ≥ 3) relative to low risk (score < 3) for OSA. We compared risk of mortality or first hospitalization with proportional hazard models, and incidence of COPD exacerbations using negative binomial regression. We adjusted analyses for demographics, body mass index, and comorbidities. Last, we compared St. George Respiratory Questionnaire and Quality of Well-Being Scale results between OSA risk groups.


Of the 222 participants studied, 164 (74%) were at intermediate to high risk for OSA based on the modified STOP-BANG score. Relative to the 58 low-risk individuals, the adjusted hazard ratio of mortality or first hospitalization was 1.61 (95% confidence interval 1.01–2.58) for those at intermediate to high risk of OSA. Risk for OSA was also associated with increased frequency of COPD exacerbations (adjusted incidence rate ratio: 1.78, 95% confidence interval 1.10–2.89). Respiratory symptoms by St. George Respiratory Questionnaire were 5.5 points greater (P = .05), and Quality of Well-Being Scale scores were .05 points lower (P < .01) among those at intermediate to high risk for OSA, indicating more severe respiratory symptoms and lower quality of life.


Among individuals with COPD, greater risk for undiagnosed OSA is associated with poor outcomes. Increased recognition and management of OSA in this group could improve outcomes.


Donovan LM, Feemster LC, Udris EM, Griffith MF, Spece LJ, Palen BN, He K, Parthasarathy S, Strohl KP, Kapur VK, Au DH. Poor outcomes among patients with chronic obstructive pulmonary disease with higher risk for undiagnosed obstructive sleep apnea in the LOTT cohort. J Clin Sleep Med. 2019;15(1):71–77.

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