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Impact of CPAP Use and Age on Mortality in Patients with Combined COPD and Obstructive Sleep Apnea: The Overlap Syndrome.
MedLine Citation:
PMID:  23946706     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
CITATION: Stanchina ML; Welicky LM; Donat W; Lee D; Corrao W; Malhotra A. Impact of CPAP use and age on mortality in patients with combined COPD and obstructive sleep apnea: the overlap syndrome. J Clin Sleep Med 2013;9(8):767-772.
Authors:
Michael L Stanchina; Lauren M Welicky; Walter Donat; David Lee; William Corrao; Atul Malhotra
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Publication Detail:
Type:  Journal Article     Date:  2013-08-15
Journal Detail:
Title:  Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine     Volume:  9     ISSN:  1550-9397     ISO Abbreviation:  J Clin Sleep Med     Publication Date:  2013  
Date Detail:
Created Date:  2013-08-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101231977     Medline TA:  J Clin Sleep Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  767-72     Citation Subset:  IM    
Affiliation:
Pulmonary/Critical Care/Sleep Medicine, Alpert School of Medicine at Brown University, Providence, RI.
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