BACKGROUND: The overlap syndrome, defined by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to define better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome. METHODS: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identified 3,396 patients which were classified in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA. Information regarding their gender, age, pulmonary function, obstructive sleep apnea parameters, and CPAP compliance was collected. A multivariate Cox proportional hazards model was generated for the determinants of mortality. RESULTS: 1,112 COPD patients and 2,284 OSA patients were identified by diagnostic coding and then comprehensive chart review. Of these, 227 patients were identified with the overlap syndrome. From this group, 17 patients (7.4%) died. Multivariate analysis revealed hours of CPAP use and age as independent predictors of mortality (HR 0.71 and 1.14, p < 0.001, 0.002). Greater time on CPAP was associated with reduced mortality; although age did not correlate with CPAP use (p = 0.2), mean age of those with CPAP use < 2 hours per night was significantly higher than those using CPAP > 2 hours per night. CONCLUSIONS: From this observational cohort, mortality in the overlap syndrome is impacted by CPAP use. Age is also an independent factor which has a negative association with survival and CPAP usage.
BACKGROUND: The overlap syndrome, defined by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to define better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome. METHODS: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identified 3,396 patients which were classified in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA. Information regarding their gender, age, pulmonary function, obstructive sleep apnea parameters, and CPAP compliance was collected. A multivariate Cox proportional hazards model was generated for the determinants of mortality. RESULTS: 1,112 COPDpatients and 2,284 OSA patients were identified by diagnostic coding and then comprehensive chart review. Of these, 227 patients were identified with the overlap syndrome. From this group, 17 patients (7.4%) died. Multivariate analysis revealed hours of CPAP use and age as independent predictors of mortality (HR 0.71 and 1.14, p < 0.001, 0.002). Greater time on CPAP was associated with reduced mortality; although age did not correlate with CPAP use (p = 0.2), mean age of those with CPAP use < 2 hours per night was significantly higher than those using CPAP > 2 hours per night. CONCLUSIONS: From this observational cohort, mortality in the overlap syndrome is impacted by CPAP use. Age is also an independent factor which has a negative association with survival and CPAP usage.
Authors: Nick A Antic; Peter Catcheside; Catherine Buchan; Michael Hensley; Matthew T Naughton; Sharn Rowland; Bernadette Williamson; Samantha Windler; R Doug McEvoy Journal: Sleep Date: 2011-01-01 Impact factor: 5.849
Authors: Jose M Marin; Joan B Soriano; Santiago J Carrizo; Ana Boldova; Bartolome R Celli Journal: Am J Respir Crit Care Med Date: 2010-04-08 Impact factor: 21.405
Authors: Bradley A Edwards; Denise M O'Driscoll; Asad Ali; Amy S Jordan; John Trinder; Atul Malhotra Journal: Semin Respir Crit Care Med Date: 2010-10-12 Impact factor: 3.119
Authors: Andrew Wellman; Atul Malhotra; Amy S Jordan; Karen E Stevenson; Shiva Gautam; David P White Journal: Respir Physiol Neurobiol Date: 2008-06-03 Impact factor: 1.931
Authors: Alec B Platt; Samuel T Kuna; Samuel H Field; Zhen Chen; Rajesh Gupta; Dominic F Roche; Jason D Christie; David A Asch Journal: Chest Date: 2009-10-09 Impact factor: 9.410
Authors: Clete A Kushida; Alejandro Chediak; Richard B Berry; Lee K Brown; David Gozal; Conrad Iber; Sairam Parthasarathy; Stuart F Quan; James A Rowley Journal: J Clin Sleep Med Date: 2008-04-15 Impact factor: 4.062
Authors: Naresh M Punjabi; Brian S Caffo; James L Goodwin; Daniel J Gottlieb; Anne B Newman; George T O'Connor; David M Rapoport; Susan Redline; Helaine E Resnick; John A Robbins; Eyal Shahar; Mark L Unruh; Jonathan M Samet Journal: PLoS Med Date: 2009-08-18 Impact factor: 11.069
Authors: Lucas M Donovan; Laura C Feemster; Edmunds M Udris; Matthew F Griffith; Laura J Spece; Brian N Palen; Ken He; Sairam Parthasarathy; Kingman P Strohl; Vishesh K Kapur; David H Au Journal: J Clin Sleep Med Date: 2019-01-15 Impact factor: 4.062
Authors: Hind A Beydoun; May A Beydoun; Xiaoli Chen; Jen Jen Chang; Alyssa A Gamaldo; Shaker M Eid; Alan B Zonderman Journal: Sleep Med Date: 2017-05-29 Impact factor: 3.492
Authors: Lucas M Donovan; Aditi Shah; Ching Li Chai-Coetzer; Ferran Barbé; Najib T Ayas; Vishesh K Kapur Journal: Chest Date: 2019-10-19 Impact factor: 9.410
Authors: Mudiaga O Sowho; Michael J Woods; Paolo Biselli; Brian M McGinley; Luis F Buenaver; Jason P Kirkness Journal: Sleep Breath Date: 2015-03 Impact factor: 2.816