Pathophysiology of the Upper Airway in Patients With COPD and Concomitant OSA
Pathophysiology of the Upper Airway in Patients With COPD and Concomitant OSA
The purpose of study is to evaluate the physiologic effects of pulmonary tissue/structural
 changes associated with COPD and upper airway inflammation on upper airway collapsibility.
 Upper airway collapsibility is closely associated with development of obstructive sleep apnea
 (OSA), which is a common disease characterized by repetitive collapse of upper airway during
 sleep, leading to hypoxemia and arousal. OSA has important neurocognitive and cardiovascular
 consequences, especially in patients with COPD.

 Participants in this research study will undergo two overnight sleep studies (PSGs),
 pulmonary function test, and CT scan of the upper airway and chest. The first sleep study
 will evaluate the sleep breathing disorder and the second sleep study will measure the upper
 airway collapsibility, called critical closing pressure (Pcrit). Pcrit is measured by a
 modified continuous positive airway pressure (CPAP) machine which can provide a wide range of
 pressures between 20 and -20 cmH2O in order to modify upper airway pressure.
This is a physiologic study to assess the effects of lower airway and lung tissue changes of
 COPD on upper airway collapsibility. Increased in lung volume and destruction of alveolar
 wall in COPD may have opposite and various effects on the upper airway collapsibility, which
 is an important factor of OSA development.

 Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are very
 common disorders associated with considerable morbidity, mortality, and healthcare costs. The
 prevalence of both co-existing conditions is estimated to be ~4% of the general population.
 This COPD-OSA "overlap" syndrome causes more severe hypoxemia than either COPD or OSA alone
 and has important clinical consequences, including death. COPD is usually excluded in OSA
 research and OSA is typically excluded or not assessed in studies of COPD; thus, available
 information about the "overlap" syndrome is limited. Therefore, it is important to identify
 patients with both COPD and OSA and determine the mechanisms of poor outcomes for these
 patients in order to optimize therapy. The pathophysiology of the COPD-OSA syndrome is not
 well understood. The investigators propose to investigate upper airway (UA) anatomic
 characteristics and collapsibility as potential underlying mechanisms that may help to
 explain the negative additive effect of having both conditions. The objectives are to study
 CT measures of airway anatomy and the critical closing pressure of the upper airway (Pcrit),
 a gold standard measure of upper airway collapsibility, in patients with COPD-OSA compared
 with COPD only and normal controls. CT scan of upper airway and chest will allow precise
 measures of upper airway characteristics and COPD associated alveolar and lower airway ch.
 angesMeasures of upper airway collapsibility will provide us information about the mechanical
 nature of the airway and if the patients are more likely to have OSA. Subjects with COPD-OSA
 may exhibit more upper airway inflammation possibly due to their pre-existing COPD disease
 and the reoccurring opening and closing of the upper airway due to the OSA. Therefore the
 investigators would like to assess the degree of inflammation in these patients compared to
 normal controls.
Inclusion Criteria for COPD Subjects:

 -  Age range 40-70 years.

 -  Demonstrated moderate to severe COPD as determined by spirometry (post-bronchodilator
 spirometry FEV1/FVC < 0.70 for diagnosing CODP and FEV1<80% predicted for staging)

 -  Smoking history of ≥ 10 pack-years

 Inclusion Criteria for Control Subjects

 -  Age range 40-70 years

 -  Demonstrated no COPD as determined by normal spirometry (post-bronchodilator
 spirometry FEV1/FVC > 0.70 for diagnosing CODP and FEV1<80% predicted for staging)

 -  No smoking history as defined by less than 100 cigarettes smoked in a lifetime

 Exclusion Criteria for both COPD and Control Subjects:

 -  Metal objects that may interfere with chest CT quantification including presence of a
 cardiac pacemaker, defibrillator, metal prosthetic heart valve, metal projectile or
 metal weapon fragment (bullet, shrapnel, shotgun shot) or metal shoulder prosthesis

 -  Subjects unable to perform spirometry due to:

 -  chest or abdominal surgery in the past three months

 -  a heart attack in the last three months

 -  detached retina or eye surgery in the past three months

 -  hospitalization for any other heart problem in the past month

 -  History of hypersensitivity to Afrin, Lidocaine or albuterol

 -  A psychiatric disorder, other than mild depression; e.g. schizophrenia, bipolar
 disorder, major depression, panic or anxiety disorders.

 -  More than 10 cups of beverages with caffeine (coffee, tea, soda/pop) per day

 -  Pregnancy or suspected pregnancy