PREVALENCE OF OBSTRUCTIVE SLEEP APNEA (OSA) RISK AND SLEEP QUALITY OF LIFE (SQOL) AMONG COPD PATIENTS OF

sleep apnea risk and sleep quality of life among COPD patients. Methodology : A descriptive study was conducted on 100 stable COPD patients at medical OPD of DMC & Hospital, Ludhiana. The subjects were selected by convenience sampling technique. Modified Berlin questionnaire was used to check OSA risk and Quebec sleep questionnaire was used for assessing SQOL among the subjects. Data was collected by self-report method. Results: The findings revealed that 72% of COPD patients (Mean age 57.1± 1.70) were at high risk of OSA while 68% showed average sleep quality of life. There was a significant association between OSA risk and SQOL among COPD patients (p = 0.00). OSA risk was also associated with married (p=0.03), non working (0.01), presence of chronic illness (p=0.00), obese (p=0.00) and bigger neck circumference (p=0.00). Conclusion: It was concluded that there was high risk of obstructive sleep apnea in COPD patients and average sleep quality of life. There is a significant association of OSA risk and sleep quality of life among COPD patients. Therefore a protocol should be made to screen the COPD patients for OSA risk. The present study revealed that out of 100 stable COPD patients, 60% patients of high risk obstructive sleep apnea had average sleep quality of life while only 12% showed good sleep quality of life as compared to 8% low risk group had average sleep quality of life and 20% had good sleep quality of life. There was a significant association between obstructive sleep apnea risk and sleep quality of life ( p= 0.00). The findings were supported by a cross-sectional descriptive study conducted by Zohal Ali Mohammad et.al (2013) on 139 COPD patients in a chest clinic of a university hospital in Iran. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for developing obstructive sleep apnea. Findings revealed that patients with overlap syndrome had worse quality of sleep compared to patients without it (P < 0.001). 7 The present study revealed that variables i.e. gender, martial status, working status, smoking habit and alcohol consumption, duration of treatment, presence of other chronic illness, BMI and neck circumference were found out to be statistically associated with obstructive sleep apnea risk of COPD patients (p<0.05). It was supported by a study conducted by Yan li et.al in China. They sequentially recruited 2,749 OSA patients treated in hospital from 2008 to 2013. BMI and WHR increased with OSA severity, in an approximately linear manner, upon univariate plotting. The Pearson correlation coefficients for BMI and WHR were 0.416 (P<0.001) and 0.229 (P<0.001), respectively. 8 the United abroad that excess body weight is uniformly associated with a graded increase in obstructive sleep apnea prevalence. Moreover, longitudinal data from the Sleep Heart Health Study, Wisconsin Sleep Cohort Study, and the Cleveland Family Study showed that an increase in body weight over time can certainly accelerate the progression of obstructive sleep apnea. 8

1046 and death. Respiratory conditions are believed to be the most commonly managed problems in general practice. Data from the Bettering the Evaluation and Care of Health survey of general practitioners suggest that they were managed at a rate of approximately 20 times per 100 encounters from 2003-04 to 2012-13 (Britt 2013). 1 Chronic Obstructive Pulmonary Disease (COPD) is a progressive inflammatory disease characterized by chronic obstruction in the peripheral bronchus and pulmonary emphysema. These diseases are disabling with symptoms such as chronic cough, phlegm, wheezing, shortness of breath and increased infections of the respiratory passage. These conditions affect the quality of life of the individual to the great extent, in which sleep disturbance is the important manifestation which need to be controlled or treated. 2 Obstructive sleep apnoea (OSA) syndrome is a common and often life-altering sleep-related breathing disorder. It not only adversely affects physical health, but the quality of life of these patients is also often significantly compromised. They experience excessive daytime sleepiness and poor cognitive, social and exercise performance. 3 It has been noted that sleep disturbances affect the life of the individual in respiratory conditions mainly COPD due to OSA. In view of this, a descriptive study is planned to assess the prevalence of obstructive sleep apnoea risk and sleep quality of life among COPD patients.
Moreover, In Indian scenario there are very few studies conducted on the prevalence of obstructed sleep apnea and associated sleep quality of life among COPD patients. Therefore, a descriptive study was planned to assess the prevalence of obstructive sleep apnoea risk and sleep quality of life among COPD patients.

Material and Methods:-
This was a descriptive study carried out at medical OPD of DMC & Hospital, Ludhiana. Stable COPD patients coming to medical OPD of DMCH who were diagnosed with COPD for more than 1 year were selected as the study sample. Convenience sampling technique was used and sample size was 100. Data was collected by self report method of data collection. Tool used for data collection included socio demographic profile, (age, gender, marital status, religion, working status, habitat, family income and socio-economic status, smoking and alcohol habits) clinical profile sheet, (Diagnosis of patient, Stages of COPD, Duration of illness, presence of any other chronic illness and vital signs of the patient, anthropometric measurements of the patients which includes BMI, waist hip ratio, neck length and neck circumference) Modified Berlin questionnaire, Quebec sleep questionnaire.
All data was entered in Microsoft excel and descriptive and inferential statistics was used for analysis of the data.
Analytical Approach:-Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) 17.0. Numerical data were summarized using means and standard deviation, while categorical data were summarized using frequencies and percentages. Comparison between groups was done usingChi-square test.

Results:-
The mean age of COPD patients was57.1± 1.70.Out of 100 COPD patients maximum number of patients were in age group of 51-70 yrs, males, married, belong to hindu religion, obtained elementary education, working, residing in the urban area and there was no remarkable difference between the dietary pattern of the patients. Near about half of patients were from middle/lower middle class III according to Kuppuswamy's SES. Percentage distribution of COPD patients as per smoking habits and 48% were non-smokers while 52% were smokers. Percentage distribution of COPD patients as per alcohol consumption and 55% were alcoholic, while 45% were non alcoholic. the percentage distribution of COPD patients as per clinical profile. Out of 100 subjects 2/3 rd (67%) were suffering from COPD ≤15 yrs and 1/3 rd (33%) of the patients were suffering from COPD >15 yrs. 2% of the patients was found in mild stage of COPD, 76% of the patient were found to be in moderate and 22% of the patients were in severe stage of COPD. Out of 100 COPD patients 60% of the patients were under treatment from ≤10 years, 40% of the patients were under treatment from >10 years. Among the subjects 63% of the patients were also suffering from other chronic illness along with COPD (diabetes mellitus 63.5%, hypertension 63.5%, coronary artery disease 23.8%, viral hepatitis 7.9%) and 37% of the patients were without any chronic illness.   The percentage distributions of the COPD patients as per anthropometric measurements. Among 100 COPD patients 42% were obese, 26% were overweighted, 25% were normal and only 7% of the patient were underweighted. Waist hip ratio shows that 39% were at moderate risk, 33% were at high risk and 28% were at low risk of developing diseases. It also shows that 72% of the patients were having neck length between 5-8 cms and 28% with neck length between 1-4 cms. Among the subjects 62% of the patients were having neck circumference between 41-45 cms, 27% were having between 36-40 cms and only 11% were with 31-35 cms. the percentage distributions of the COPD patients as per anthropometric measurements. Among 100 COPD patients 42% were obese, 26% were overweighted, 25% were normal and only 7% of the patient were underweighted. Waist hip ratio shows that 39% were at moderate risk, 33% were at high risk and 28% were at low risk of developing diseases. It also shows that 72% of the patients were having neck length between 5-8 cms and 28% with neck length between 1-4 cms. Among  This study showed that 72% of COPD patients were at high risk for developing obstructive sleep apnea while only 28% of COPD patients were at low risk of OSA.

52%
Hence it was concluded that COPD patients were significantly at high risk of developing OSA.
The sleep quality of life (SQOL) among COPD patients. It revealed that 68% of COPD patients had average SQOL with mean score 126.63± 12.30 while 32% of COPD patientshad good SQOL with mean score 173.65± 14.84. Therefore, it was concluded that SQOL was altered in COPD patients. Chronic Obstructive Pulmonary Disease (COPD) is very common disease leading to frequent physician visits and hospitalizations and become the 3 rd leading cause of death. Sleep related disturbances like OSA is very common among COPD patients. OSA occurs in about 10 to 15% of patients with COPD, a condition referred to as the "overlap syndrome". Although the prevalence of OSA is similar in patients with COPD as in the general population, individuals with both conditions without Continuous Positive Airway Pressure (CPAP) treatment have an increased risk of death and more hospitalizations from acute exacerbations.
As OSA in COPD can cause various serious complications, it also affects the quality of life of the individual. So researcher has planned to conduct a descriptive study to assess the prevalence of obstructive sleep apnea risk and sleep quality of life among COPD patients of a tertiary care hospital, Ludhiana, Punjab.
The analysis of socio demographic profile of COPD patients revealed that out of 100 subjects, 83% of COPD patients were in age group 51-75 years, 75 were males, 83% were married, 57% were educated up to elementary level, 54% were working, 72% were Hindu, 66% were residing in urban area, and 48% were in middle/lower middle class.
According to their personal habits related to smoking and alcohol consumption 52% of COPD patients were smokers and 55% were alcoholic. As per their clinical profile 67% were having COPD ≤15 years, 78% of the patients were in moderate stage of illness, 60% of the patients were undergoing treatment from ≤10 years and 63% of the patients were suffering from another chronic illness along with COPD.
According to the vital signs of the patients, 58% were having normal heart rate, 85% were having abnormal respiratory rate, 79% of the patients were having normal body temperature and 62% of the patients were having normal blood pressure.
Atlast according to the anthropometric measurements, 42% of the COPD patients were obese, 39% of the patients were having moderate risk according to the waist hip ratio, 72% of the patients were having neck length of 5-8 cms and 62% of them were neck circumference of 41-45 cms.
The present study revealed that maximum subjects (72%) had high risk of developing obstructive sleep apnea whereas only 28% of subjects had low risk of developing obstructive sleep apnea.
This finding was supported by Feinsilver Steven et.al (2010) who conducted a prospective observational study in USA to determine whether reduced pulmonary function in obstructive airway disease (OAD) is an independent risk factor for obstructive sleep apnea. Berlin Questionnaire (BQ) was used. The prevalence of patients with a high risk of OSA was 55.2% in the OAD group, which was higher than in family members without history of OAD(7.5%, p < 0.0001). 4 It was also supported by a study conducted by Community-based studies conducted in the United States and abroad have since confirmed that excess body weight is uniformly associated with a graded increase in obstructive sleep apnea prevalence. Moreover, longitudinal data from the Sleep Heart Health Study, Wisconsin Sleep Cohort Study, and the Cleveland Family Study showed that an increase in body weight over time can certainly accelerate the progression of obstructive sleep apnea. 8 Epidemiologic studies have confirmed the higher prevalence of obstructive sleep apnea in men. Epidemiologic investigations also showed that current smoking is associated with a higher prevalence of snoring and obstructive sleep apnea. Even exposure to second-hand smoke has been independently linked with habitual snoring. 8 Ingestion of alcohol before sleep has been shown to increase upper airway collapsibility and precipitate obstructive apneas and hypopneas during sleep. 8