Purpose:The relationship between Obstructive sleep apnea (OSA) and hypercoagulability remains unclear. To address this uncertainty, the present study combined observational and Mendelian randomization (MR) analyses to assess the associations of OSA and coagulation markers. Patients and Methods:We conducted an observational study of 790 patients with OSA, evaluating associations between OSA severity and coagulation markers, including activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen (Fib). Multivariate linear regression adjusted for age, gender, body mass index (BMI), and comorbidities. Additionally, we performed a large-scale Mendelian randomization analysis using two East Asian OSA genome-wide association study (GWAS) datasets (Million Veteran Program [MVP], n=6550; Taiwan Precision Medicine Initiative [TPMI], n=316351) as exposures, and East Asian coagulation GWAS data from BioBank Japan (BBJ) as outcomes (APTT: n=37767; Fib: n=18348; PT: n=58110). Multivariable MR (MVMR) with body mass index (BMI)(TPMI GWAS, n=191458) was performed to assess residual direct effects of OSA. Results:Severe OSA showed higher Fib (p-value<0.01) and shorter PT (p-value<0.05) and APTT (p-value<0.05) than mild-moderate OSA. Multivariate regression analysis showed T90 (the percentage of time oxygen saturation is below 90%) and MSaO2 (mean oxygen saturation) were associated with Fib (β=-0.259; β=-0.224, p-value<0.001). While OSA severity is observationally associated with subclinical hypercoagulability, these significances vanished after adjusting for BMI and are not supported by genetic evidence since MR analyses provide no evidence for a moderate or clinically meaningful independent causal effect between genetic OSA liability and coagulation markers. MVMR confirmed no residual direct effect of OSA on coagulation after accounting for BMI. Conclusion:Severe OSA is associated with subclinical hypercoagulability, but this relationship is confounded by BMI. Genetic evidence does not support a moderate or clinically meaningful causal role for OSA in coagulation dysfunction, urging a paradigm shift toward obesity management as the primary strategy to reduce thrombotic risk in OSA patients.

BackgroundObstructive sleep apnea (OSA) is associated with multiple systemic complications. However, evidence-based recommendations for comorbidity screening remain sparse. This study aimed to evaluate whether a structured comorbidity workup could yield clinically meaningful diagnostic gains in OSA patients.MethodsIn this single-center cross-sectional observational study, patients diagnosed with OSA underwent a standardized comorbidity assessment including laboratory tests, electrocardiogram, echocardiography, abdominal ultrasound, ambulatory blood pressure monitoring, spirometry, and validated questionnaires.ResultsA total of 1904 OSA patients were included. Before evaluation, patients had a median of two [IQR 1-2] known comorbidities. The structured workup identified 3,200 newly diagnosed conditions, with a median of two [IQR 1-2] new diagnoses per patient. The most frequent comorbidities were dyslipidaemia (55%), type 2 diabetes mellitus (32%), metabolic syndrome (31%), hypertension (30%), non-alcoholic fatty liver disease(29%), hyperuricemia (29%), significant coronary artery disease (15%), arrhythmia (16%), heart failure with preserved ejection fraction (13%), obesity hypoventilation syndrome (19%), chronic obstructive pulmonary disease (8%) , asthma (12%), gastro-oesophageal reflux disease (17%), anxiety or depression (17%), and thyroid dysfunction (6%). Older age, male sex and lower mean oxygen saturation were independently associated with a higher comorbidity burden. Newly identified conditions led to pharmacological treatment changes in 40%, specialist referral in 54%, and lifestyle interventions in 85% of cases.ConclusionA structured comorbidity workup in OSA patients reveals a high prevalence of previously unrecognized, clinically actionable conditions, particularly cardiometabolic disorders. Integrating systematic screening into routine OSA care may improve risk stratification, treatment optimization, and prevention of adverse outcomes (See Graphic Abstract).

Although a general association between nocturnal hypoxemia or sleep-disordered breathing (SDB) and pulmonary arterial hypertension has been established, little is known about the unique pathophysiologic contributions of SDB and nocturnal hypoxemia to chronic thromboembolic pulmonary disease (CTEPD). We therefore chose to examine the associations of SDB and nocturnal hypoxemia with hemodynamic indices obtained via right heart catheterization (RHC) in hospitalized patients with CTEPD. We hypothesized that the severity of CTEPD would be associated with SDB and nocturnal hypoxemia severity. Patients with CTEPD with or without pulmonary hypertension (PH) who had undergone polysomnography (PSG) between July 2022 and March 2024 were enrolled. A nocturnal mean oxygen saturation by pulse oximetry (MeanSpO2) < 90

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) show a relatively high prevalence of obstructive sleep apnea (OSA). The association between OSA and CTEPH is of critical importance, as their coexistence significantly endangers health. The gut microbiota is known to play a central and decisive role in the progression of cardiopulmonary diseases. However, the specific alterations and underlying mechanisms in the context of OSA and CTEPH comorbidity remain largely obscure and urgently require in-depth exploration. Participants were recruited from China-Japan Friendship Hospital and divided into three groups: healthy controls (Controls, n = 12), OSA (n = 12), and CTEPH + OSA (n = 12). Fecal samples were collected from participants to extract bacterial DNA for 16S rRNA sequencing. Meanwhile, clinical indices such as right heart catheterization parameters, blood gas analysis, inflammatory factors, and coagulation indices were collected. Compared to the Controls, the CTEPH + OSA group displayed a marked deterioration in mean pulmonary arterial pressure, significant aberrations in AHI, and a pronounced activation of inflammatory and coagulation cascades. Notably, the gut microbiota diversity was significantly diminished, accompanied by a distinct alteration in the Firmicutes/Bacteroidetes ratio. There was a notable depletion of specific beneficial bacteria and a concurrent increase in harmful taxa. Spearman correlation analysis demonstrated that the reduced abundance of Faecalibacterium was significantly negatively correlated with IH-related indicators like AHI and T90, and was positively correlated with the mean SpO2. (P < 0.05). Compared to the isolated OSA group, the CTEPH + OSA cohort exhibited unique and characteristic shifts in microbiota structure and functional prediction pathways. The abundance of Faecalibacterium, in particular, demonstrated a highly significant and close correlation with the severity of CTEPH, underpinning its potential as a crucial biomarker. Gut microbiota dysregulation occurs in CTEPH patients with OSA, and IH may be involved. This affects the gut barrier and inflammatory response, providing new targets and ideas for improving the prognosis of CTEPH patients with OSA. Future larger sample studies and mechanism explorations are warranted. 1.Elite Medical Professionals Project of China-Japan Friendship Hospital□NO.ZRJY2024-QMPY14); 2.National High Level Hospital Clinical Research Funding.

Obstructive sleep apnea (OSA) is associated with increased risks of glucolipid metabolic disruption, endocrine disturbances and psychological distress. There is scarce research regarding the influence of sex on these associations. The current study aimed to evaluate the effects of sex on metabolic, endocrine and psychological changes in patients with OSA. One hundred sixty-four young adult women and one hundred sixty-two age-matched men with OSA completed polysomnography assessments, questionnaires (including the Epworth Sleepiness Scale [ESS], Self-Reported Anxiety Scale [SAS], Self-Rating Depression Scale [SDS], and 12-Item Short-Form Health Survey [SF-12]) and biochemical analyses for glucolipid metabolism and endocrine function, including the pituitary-adrenal (PA), pituitary thyroid (PT), and pituitary–gonadal (PG) axes. Homeostasis model assessment of insulin resistance (HOMA-IR), thyroid hormone and midnight PA axis activity levels were greater in female patients with severe OSA compared to those with mild-to-moderate OSA, and these metabolic and endocrine changes were associated with nocturnal hypoxia only in female patients. Additionally, midnight cortisol was associated with HOMA-IR (independent of anthropometry and sleep disturbance parameters) in females (β = 0.545, P = 0.012, adjusted R2 = 0.217). ESS was higher for male patients with severe OSA compared to females with the same level of OSA (P = 0.003), and ESS was associated with nocturnal hypoxia in males (β = − 0.494, P = 0.001, adjusted R2 = 0.224). SAS was higher for female patients with severe OSA compared to males with the same level of disease (P = 0.001). The metabolic, endocrine and psychological consequences of OSA may differ across sexes. The associations of nocturnal hypoxia with glucose metabolic disturbance and the activation of the PA and PT axes were observed in females, whereas the association of nocturnal hypoxia with ESS was limited to males. This could indicate a distinct metabolic, endocrine and psychological phenotype for female patients with OSA, who may require different disease management strategies compared to males. This study investigated the effects of sex on metabolic, endocrine and psychological changes in patients with obstructive sleep apnea (OSA). One hundred sixty-four young adult women and one hundred sixty-two age-matched men with OSA completed sleep monitoring assessments; questionnaire surveys regarding daytime sleepiness, anxiety, and depression; and biochemical tests for glucolipid metabolism and endocrine function (including hormones related to the adrenal gland, thyroid gland and gonads). We observed that women with severe OSA exhibited lower insulin sensitivity, elevated thyroid hormone levels, and greater activation of the adrenal axis at night than women with mild-to-moderate OSA. Interestingly, these metabolic and hormonal changes were linked to nighttime hypoxia only in women. Additionally, the activation of the adrenal axis at night was related to insulin sensitivity in women, which was independent of age, body weight and sleep disturbance. Daytime sleepiness was more sever for men with severe OSA compared to women with the same level of OSA, and daytime sleepiness was associated with nocturnal hypoxia in men, whereas anxiety was more severe for severe OSA compared to mild-to-moderate OSA in women. These findings suggest that the metabolic, endocrine and psychological changes associated with OSA may differ between men and women. Women are more prone to metabolic and hormonal disruptions caused by nocturnal hypoxia and are more vulnerable to anxiety, whereas men are more likely to experience daytime sleepiness as a key symptom.

There is no satisfactory treatment for obstructive sleep apnea (OSA) in patients with interstitial lung disease (ILD) because of poor tolerance of positive airway pressure (PAP) therapy. Supplemental oxygen therapy has been shown to reduce hypoxemia and is well tolerated in patients with ILD. However, little is known about the effect of nocturnal oxygen supplementation (NOS) on OSA in patients with ILD. In this study, we evaluated one night of oxygen therapy in ILD patients with OSA. Forty-one patients with fibrotic ILD and OSA were randomized to receive supplemental oxygen or air for one night each in a crossover design separated by a washout period of one week. Polysomnography was performed, and sleep-disordered breathing, nocturnal desaturation, sleep architecture, and cardiovascular reactions were monitored. During nights with sham oxygen, the median (interquartile range) apnea–hypopnea index (AHI) was 14.1/h (10.4/h–24.1/h). The percentage of patients in the N3 sleep stage (N3

BackgroundMaternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. ObjectiveThis study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). MethodsThis case-control study used data from the nationwide cross-sectional China Pulmonary Health study, with controls matched for age, sex, and smoking status. TD was defined as smoking within 30 minutes of waking, and the severity of TD was assessed using the Fagerstrom Test for Nicotine Dependence. COPD was diagnosed when the ratio of forced expiratory volume in 1 second to forced vital capacity was <0.7 in a postbronchodilator pulmonary function test according to the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Logistic regression was used to examine the correlation between MSDP and COPD, adjusting for age, sex, BMI, educational attainment, place of residence, ethnic background, occupation, childhood passive smoking, residential fine particulate matter, history of childhood pneumonia or bronchitis, average annual household income, and medical history (coronary heart disease, hypertension, and diabetes). Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the “bootstrap” method. ResultsThe study included 5943 participants (2991 with COPD and 2952 controls). Mothers of the COPD group had higher pregnancy smoking rates (COPD: n=305, 10.20%; controls: n=211, 7.10%; P<.001). TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). After adjusting for covariates, MSDP had a significant effect on COPD (β=.097; P<.001). There was an association between MSDP and TD (β=.074; P<.001) as well as between TD and COPD (β=.048; P=.007). Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: β=.094; P<.001 and indirect: β=.004; P=.03). The indirect effect remains present in the smoking population (direct: β=.120; P<.001 and indirect: β=.002; P=.03). ConclusionsThis study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. These findings contribute to a deeper understanding of the impact of prenatal tobacco exposure on lung health, laying the groundwork for the development of relevant prevention and treatment strategies.

目的 运动时血氧饱和度(the oxygen saturation,SpO2)下降对慢性呼吸系统疾病具有重要的临床与预后意义.本研究旨在探讨间质性肺疾病(interstitial lung disease,ILD)患者运动性低氧(exercise induced desaturation,EID)的临床和生理预测指标,并与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者进行对比分析.方法 回顾性分析2015年9月至2018年12月于中日友好医院呼吸与危重症医学科就诊的79例ILD患者与68例COPD患者的6分钟步行试验(6-minute walking test,6MWT)和肺功能结果,其中主要结局指标是运动中最低血氧饱和度(minimum saturation of peripheral oxygen,SpO2min)、静息血氧饱和度与运动过程中最低血氧饱和度差值(the difference between resting and minimum saturation of peripheral oxygen,?SpO2).结果 ILD和COPD组性别、6分钟步行距离、6分钟步行距离占预计值百分比及SpO2rest差异无显著性(P>0.05).与COPD组比较,ILD组6MWT期间SpO2min更低[87.0(79.0,93.0)比90.0(87.0,94.0),P=0.02],?SpO2更大[4.0(2.0,10.0)比2.0(1.0,4.0),P<0.01].多元回归分析显示,一氧化碳弥散量是ILD和COPD两组患者发生EID的独立预测因子.结论 ILD患者比COPD患者发生EID的情况更严重,提示有必要在慢性呼吸系统疾病康复锻炼中采取疾病特异性的干预和氧疗方案.

Abstract Background Adiposity is a well-established risk factor for obstructive sleep apnea (OSA), but whether a combination of preferable anthropometric measurements may improve the accuracy of detecting OSA is unknown. This study aimed to explore the accuracies of the waist-hip ratio (WHR) in conjunction with the body mass index (BMI) when identifying the severity of OSA. Design A total of 2012 participants in the China-Japan Friendship Hospital from January 2018 to December 2019 underwent anthropometric measurements and an overnight home sleep test (HST). The 244 subjects who met the criteria for obstructive sleep apnea (apnea–hypopnea index (AHI) ≥ 5 events/hour) were divided into four groups: Group A (55 patients with WHR ≥ 0.9 and BMI ≥ 28 kg/m2); Group B (12 patients with WHR < 0.9 and BMI ≥ 28 kg/m2); Group C (69 patients with WHR ≥ 0.9 and BMI < 28 kg/m2); and group D (108 patients with WHR < 0.9 and BMI < 28 kg/m2). Results The AHI, apnea index (AI), hypopnea index (HI), and oxygen desaturation index (ODI) were significantly different among the 4 groups (p < 0.05). The WHR was positively correlated with AHI (r = 0.22, p < 0.001), AI (r = 0.270, p = 0.004), and ODI (r = 0.286, p = 0.0022) and negatively correlated with lowest oxygen pulse saturation (LSpO2) (r = 0.246, p = 0.008) only in nonobese patients. Moreover, the WHR was found to be a screening marker for moderate-to-severe OSA in Group D (p < 0.05). When used to identify severe OSA in Group D, the WHR cut-off point of 0.873 yielded a sensitivity of 65% and specificity of 56% (p < 0.05). Conclusion In nonobese male OSA patients, WHR is a moderate screening marker for moderate-to-severe OSA and an independent risk factor for OSA severity.

Background: Studies on the association of greenness with respiratory health are scarce in developing countries, and previous studies in China have focused on only one or two indicators of lung function.Objective: The study aims to evaluate the associations of residential greenness with full-spectrum lung function indicators and prevalence of chronic obstructive pulmonary disease (COPD).Methods: This nationwide cross-sectional survey included 50,991 participants from the China Pulmonary Health study. Lung function indicators included four categories: indicators of obstructive ventilatory dysfunction (FEV1, FVC and FEV1/FVC); an indicator of large-airway dysfunction (PEF); indicators of small-airway dysfunction (FEF25-75% and FEV3/FEV6); and other indicators. Residential greenness was assessed by the Normalized Difference Vegetation Index (NDVI). Multivariable linear regression models and logistic regression models were used to analyze associations of greenness with lung function and COPD prevalence.Results: Within the 500 m buffer, an interquartile range (IQR) increase in NDVI was associated with higher FEV1 (24.76 mL), FVC (16.52 mL), FEV1/FVC (0.38), FEF50% (56.34 mL/s), FEF75% (33.43 mL/s), FEF25-75% (60.73 mL/s), FEV3 (18.59 mL), and FEV6 (21.85 mL). However, NDVI was associated with lower PEF. In addition, NDVI was significantly associated with 10% lower odds of COPD. The stratified analyses found that the associations were only significant in middle-young people, females, and nonsmokers. The associations were influenced by geographic regions.Conclusions: Residential greenness was associated with better lung function and lower odds of COPD in China. These findings provide a scientific basis for healthy community planning.

Obstructive sleep apnea (OSA) is prevalent in patients with idiopathic pulmonary fibrosis (IPF), and the complex coupling of biomechanics, neural reflex and airway inflammation and their interaction mechanism exist in the two.The value of simple OSA screening questionnaire in diagnosis of OSA existing in patients with interstitial lung disease is limited.Currently, the study regarding continuous positive airway pressure in the treatment of IPF with OSA is rare, and the conclusions are still controversial, therefore, the effect of nocturnal oxygen therapy on IPF with OSA needs to be further assessed.

Background Chronic cough is a common complaint, but there are no population-based data on its burden in China. We determined the prevalence of chronic cough and its impact on health status in adults stratified by sex, age and the diagnosis of COPD or the presence of small airway dysfunction (SAD). Methods A representative sample of 57 779 Chinese adults aged 20 years or older was recruited and pulmonary function test was measured. Chronic cough was defined as cough lasting for >3 months in each year. Quality of life was assessed by the 12-item Short Form Health Survey (SF-12), and self-reported history of hospital visits was recorded. Results Chronic cough was found in 3.6% (95% CI 3.1–4.1) of Chinese adults, 2.4% (95% CI 1.9–3.1) of those aged 20–49 years and 6.0% (95% CI 5.3–6.8) of those aged 50 years or older. Individuals with chronic cough had an impaired physical component summary (PCS) score of the SF-12 (p<0.0001) and more emergency visits (p=0.0042) and hospital admissions (p=0.0002). Furthermore, the impact of chronic cough on PCS score was more significant in those aged 50 years or older, or with COPD (p=0.0018 or 0.0002, respectively), with the impact on hospital admission being more significant in those with COPD or with SAD (p=0.0026 or 0.0065, respectively). Conclusions Chronic cough is prevalent in China and is associated with a poorer health status, especially in individuals aged 50 years or older and those with the diagnosis of COPD or SAD.

Rationale: It remains unknown whether long-term ozone exposure can impair lung function. Objectives: To investigate the associations between long-term ozone exposure and adult lung function in China. Methods: Lung function results and diagnosis of small airway dysfunction (SAD) were collected from a cross-sectional study, the China Pulmonary Health Study (N = 50,991). We used multivariable linear and logistic regression models to examine the associations of long-term ozone exposure with lung function parameters and SAD, respectively, adjusting for demographic characteristics, individual risk factors, and longitudinal trends. We then performed a stratification analysis by chronic obstructive pulmonary disease (COPD). Measurements and Main Results: We observed that each 1 SD (4.9 ppb) increase in warm-season ozone concentrations was associated with a 14.2 ml/s (95% confidence interval [CI], 8.8-19.6 ml/s] decrease in forced expiratory flow at the 75th percentile of vital capacity and a 29.5 ml/s (95% CI, 19.6-39.5 ml/s) decrease in mean forced expiratory flow between the 25th and 75th percentile of vital capacity. The odds ratio of SAD was 1.09 (95% CI, 1.06-1.11) for a 1 SD increase in warm-season ozone concentrations. Meanwhile, we observed a significant association with decreased FEV1/FVC but not with FEV1 or FVC. The association estimates were greater in the COPD group than in the non-COPD group. Conclusions: We found independent associations of long-term ozone exposure with impaired small airway function and higher SAD risks, while the associations with airflow obstruction were weak. Patients with COPD appear to be more vulnerable.

Objective:To explore the clinical value of Somnolyzer system in automated scoring of polysomnography (PSG).Methods:This is a diagnostic test study.A non-random sampling method was used to enroll 138 patients underwent overnight PSG monitoring in Sleep clinic, China-Japan Friendship Hospital from March 2017 to October 2019.Each original PSG was manually scored by two experienced technologists (M1, M2), and the same original PSG was scored by Somnolyzer system to obtain automatic score (S), and the two technologists edited the automatic score and obtained two modified polysomnography scores (SM1, SM2). The intraclass correlation coefficient (ICC) was used to assess the consistency between groups.Sleep staging and respiratory events scores were conducted according to the 2007 American Academy of Sleep Medicine (AASM) criteria.Results:There were good agreements of five methods for the main parameters in both sleep structure and respiratory events.For sleep structure parameters, average ICC and 95% CI within 5 groups were: percentage of sleep stage N1 (N1%): 0.973, 95% CI (0.965-0.979); N2%: 0.898, 95% CI (0.869-0.923); N3%: 0.951, 95% CI (0.937-0.963); R%: 0.964, 95% CI (0.954-0.973); total sleep time (TST): 0.991, 95% CI (0.988-0.993); sleep latency (SL): 0.933, 95% CI (0.913-0.949); sleep efficiency (SE): 0.972, 95% CI (0.964-0.979); arousal index (ArI): 0.991, 95% CI (0.989-0.994). For respiratory events, average ICC and 95% CI within 5 groups were: obstructive apnea index (OAI): 0.989, 95% CI (0.986-0.992); central apnea index (CAI): 0.994, 95% CI (0.992-0.995); mixed apnea index (MAI): 0.998, 95% CI (0.997-0.998); hypoventilation index: 0.988, 95% CI (0.984-0.991); apnea hypopnea index (AHI): 0.992, 95% CI (0.990-0.994); oxygen desaturation index (ODI): 0.999, 95% CI (0.998-0.999); duration of oxygen desaturation: 0.913, 95% CI (0.888-0.934); respiratory effort related arousal (RERA) index: 0.964, 95% CI (0.953-0.972). Conclusions:No difference was significant in the interpretation of sleep parameters and respiratory events between the Somnolyzer automated scoring system and manual scoring, with good consistency.Considering the burden imposed by manual scoring, automated scoring systems may serve as an alternative complementary means of PSG scoring.

Objective We aimed to establish an easy-to-use screening questionnaire with risk factors and suspected symptoms of COPD for primary health care settings. Methods Based on a nationwide epidemiological study of pulmonary health among adults in mainland China (China Pulmonary Health, CPH study) between 2012 and 2015, participants ≥40 years who completed the questionnaire and spirometry tests were recruited and randomly divided into development set and validation set by the ratio of 2:1. Parameters including sex, age, BMI, residence, education, smoking status, smoking pack-years, biomass exposure, parental history of respiratory diseases and daily respiratory symptoms were initially selected for the development of scoring system. Receiver operating characteristic (ROC) curve, area under curve (AUC), positive and negative predictive values were calculated in development set and validation set. Results After random split by 2:1 ratio, 22443 individuals were assigned to development set and 11221 to validation set. Ten variables were significantly associated with COPD independently in development set after a stepwise selection by multivariable logistic model and used to develop scoring system. The scoring system yielded good discrimination, as measured by AUC of 0.7737, and in the validation set, the AUC was 0.7711. When applying a cutoff point of ≥16, the sensitivity in development set was 0.69 (0.67 − 0.71); specificity 0.72 (0.71 − 0.73), PPV 0.25 (0.24 − 0.26) and NPV 0.94 (0.94 − 0.95). Conclusion We developed and validated a comprehensive screening questionnaire, COPD-CPHS, with good discrimination. The score system still needs to be validated by large cohort in the future. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2042504 .

BackgroundPatients with features of both asthma and chronic obstructive pulmonary disease (COPD) are seen commonly in the clinic but less is known in the general population. We investigated the prevalence and the heterogeneity of COPD with concomitant features of asthma in Chinese adult population.MethodsCOPD was defined as post-bronchodilator ratio of forced expiratory volume in 1s (FEV1) to forced vital capacity of less than the lower limits of normal. COPD with concomitant features of asthma was defined as either COPD with asthma diagnosed by self-reported physician-diagnosis or by presence of current wheeze, or as COPD with high bronchodilator response (HBR) defined as an increase in FEV1 >15% and >400 ml after bronchodilator.ResultsCOPD with concomitant features of asthma was found in 1.62% (95% CI 1.31–2.00) of adults (≥20 years) or in 15.2% (95% CI 13.0–17.7) of COPD patients. Compared with COPD with HBR, COPD with asthma diagnosis or wheeze were older (61.8 ± 1.1 years vs. 47.4 ± 2.8 years, P < 0.001), and with a lower post-bronchodilator FEV1%pred (68.2 ± 2.3 vs. 96.6 ± 3.4, P < 0.001). Age, smoking status, biomass use and allergic rhinitis were associated with increasing prevalence of COPD with asthma diagnosis or wheeze, and had greater impaired health status, more comorbidities and more acute exacerbations in the preceding 12 months.ConclusionsCOPD with concomitant features of asthma is common in people with COPD and those with COPD with asthma diagnosis or wheeze experience worse clinical severity than COPD with HBR. These findings will help toward the definition of the asthma-COPD overlap condition.

Background and Objective Clinical and population-based studies have demonstrated a strong association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD). Anatomical abnormalities of the craniofacial region and upper airway are important risk factors for OSA. The objective of this study was to investigate the association of craniofacial and upper airway morphology with CVD risk biomarkers. Methods One hundred and sixty-nine male patients with OSA underwent in-laboratory polysomnography (PSG) and upper airway computed tomography (CT) scanning. Ten-year Framingham CVD risk score (FRS) was calculated and categorized into low- and moderate-to-high-risk groups. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured as a biomarker of increased myocardial wall stress. Results Compared to the low-risk group, total sleep time (TST), the proportion of N3 (N3%) and mean oxygen saturation (SpO2mean) were lower, while the arousal index of non-rapid eye movement (NREM) sleep, apnea index (AI) of NREM sleep, apnea hypopnea index (AHI) of NREM sleep, oxygen desaturation index (ODI) and percentage of total sleep time spent with oxyhemoglobin saturation below 90% (TST90) were higher in the moderate-to-high risk group. The corrected upper airway length (UAL), ANB angle and gonion-gnathion-hyoid angle were larger for subjects in the moderate-to-high risk group than those in the low-risk group. In multiple regression analysis, TST, AINREM and adjusted UAL were independently associated with moderate-to-high CVD risk. Plasma NT-proBNP levels were higher in patients in the moderate- to high-risk group, and among the PSG and CT scan parameters, only SPO2mean was marginally associated with NT-proBNP (r=0.183, P=0.054). Conclusion Craniofacial and upper airway features may contain valid cues about CVD risk, and sleep duration, obstructive event type and occurrence phase may be closely related to CVD risk for patients with OSA.

The associations of long-term exposure to various constituents of fine particulate matter (≤2.5 μm in aerodynamic diameter, PM2.5) air pollution with lung function were not clearly elucidated in developing countries. The aim was to evaluate the associations of long-term exposure to main constituents of PM2.5 with lung function in China. This is a nationwide, cross-sectional analysis among 50,991 study participants from the China Pulmonary Health study. Multivariable linear regression models were used to obtain differences of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow at 25–75% of exhaled FVC (FEF25-75%) associated with an interquartile range (IQR) change of PM2.5 or its constituents. Residential annual PM2.5 levels varied from 26 μg/m3 to 92 μg/m3 (average: 53 μg/m3). An IQR increase of PM2.5 concentrations was associated with lower FEV1 (19.82 mL, 95% CI: 11.30–28.33), FVC (17.45 mL, 95% CI: 7.16–27.74), PEF (86.64 mL/s, 95% CI: 59.77–113.52), and FEF25-75% (31.93 mL/s, 95% CI: 16.64–47.22). Black carbon, organic matter, ammonium, sulfate, and nitrate were negatively associated with most lung function indicators, with organic matter and nitrate showing consistently larger magnitude of associations than PM2.5 mass. This large-scale study provides first-hand epidemiological evidence that long-term exposure to ambient PM2.5 and some constituents, especially organic matter and nitrate, were associated with lower large- and small- airway function.

Background Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. Methods From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV, and FEV,/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. Findings Overall the prevalence of small airway dysfunction was 43.5% (95% CI 40.7-46.3), pre-small airway dysfunction was 25.5% (23.6-27.5), and post-small airway dysfunction was 11.3% (10.3-12.5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2.5 mu m (PM2.5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m(2). The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or presmall airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2.5, and increase of BMI by S kg/m(2) were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. Interpretation In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2.5 exposure and increase of BMI by 5 kg/m(2). Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. Copyright (C) 2020 Elsevier Ltd. All rights reserved.