Dynamic Risk Status of OSA and Its Association with COPD Incidence and Progression to Oxygen Therapy: Insights from a US National Cohort

Yuxin Wang, Jinmei Luo, Rong Huang, Yi Xiao Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Yi Xiao, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of China, Email [email protected]: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are prevalent respiratory disorders with significant health implications. This study investigates the relationship between OSA risk and the incidence and progression of COPD.Patients and Methods: We analyzed data from the Health and Retirement Study (HRS) cohort. Participants’ OSA risk was assessed using the STOP-Bang questionnaire. Changes in OSA risk were evaluated by comparing baseline and follow-up assessments. COPD incidence and progression were determined through self-reported physician diagnoses and the use of oxygen therapy. After adjusting for covariates, hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazards models.Results: The analysis included 14398 participants for baseline OSA risk and 11177 for OSA risk changes. Participants with high baseline OSA risk had a significantly higher risk of developing COPD (adjusted HR: 1.255, 95% CI: 1.054– 1.496) compared to those with low risk, although no significant relationship was found with progression to oxygen therapy. Participants whose OSA risk decreased showed a lower risk of developing COPD (Baseline low-risk group: adjusted HR: 0.603, 95% CI: 0.418– 0.871; Baseline high-risk group: adjusted HR: 0.586, 95% CI: 0.396– 0.869). This relationship was significant in women but not in men. Changes in OSA risk were not significantly related to COPD progression to oxygen therapy.Conclusion: OSA risk and its changes are associated with varying risks of COPD. Progression in OSA risk increases the risk of COPD, while improvement in OSA risk reduces it.Keywords: obstructive sleep apnea, chronic obstructive pulmonary disease, STOP-Bang, epidemiology, dynamic nature