SESSION TYPE: Sleep II
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Despite empiric therapy for gastro-esophageal reflux (GERD), cough-variant asthma (CVA) and upper airway cough syndrome (UACS), chronic cough remains unresolved in a significant percentage of patients. Recent evidence suggests improvement in chronic cough following therapy for concomitant OSA.
METHODS: Non-smoking patients with cough more than 2 months and normal chest radiographs and normal spirometry were evaluated for OSA using screening STOP-BANG questionnaires. Nocturnal oximetry and attended polysomnography (PSG) were performed following further clinical evaluation per clinician discretion. Treatment for GERD, UACS, and CVA was done per the patient's provider (pulmonologist or primary care physician). At enrollment, screening questionnaires for GERD, asthma, rhinosinus disease, daytime sleepiness and cough severity were administered. Cough severity was assessed during each patient visit using the Leicester Cough Questionnaire (LCQ). Prevalence of OSA risk based on STOP-BANG scores and PSGs was determined. LCQ scores were compared using paired t-test in patients pre- and post-CPAP therapy to assess benefit from therapy of concomitant OSA in patients with chronic cough.
RESULTS: 37 patients with chronic cough were enrolled into the study. Only 28 patients (18 female; 10 male) had serial LCQ scores 2 or more times, therefore 9 patients were excluded. Mean age of patients was 55 years (±15) and BMI of patients was 32.5 (±6.9) with an average duration of cough for 27 months. Using a STOP-BANG questionnaire score of 3 or more, prevalence of patients wth increased OSA risk was 75% (21/28). 13 patients underwent oximetry, all of which were abnormal. PSGs were performed in 17/21 patients with STOP-BANG scores of 3 or more. 2 patients had known OSA but had not been compliant with CPAP, and were started on CPAP without PSGs. 2 patients refused further sleep apnea evaluations. Mean apnea-hypopnea index (AHI) was 35/hr (numbers of patients with mild OSA- 6/17; moderate OSA-4;/17 severe OSA-7/17). CPAP therapy was provided in 19 patients (17 with abnormal AHI values (>5/hour) on PSG and two with known but untreated OSA). Improvement in LCQ scores was noted in patients following CPAP therapy (mean±SD change:4.12 ± 4.85; p= 0.001).
CONCLUSIONS: Obstructive sleep apnea is highly prevalent in patients with chronic cough. CPAP therapy in those with concomitant OSA results in improvement in validated cough intensity measures.
CLINICAL IMPLICATIONS: Screening and therapy for OSA is recommended in all chronic cough patients.
DISCLOSURE: The following authors have nothing to disclose: Krishna Sundar, Sarah Daly, Alika Willis
No Product/Research Disclosure InformationUniversity of Utah, Salt Lake City, UT