A RECENT study highlights the potential survival benefits of long-term positive airway pressure (PAP) therapy for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA). The study compared outcomes for patients hospitalised with acute hypercapnic respiratory failure who had COPD alone versus those with COPD-OSA overlap syndrome (OVS), revealing a trend toward lower mortality among OVS patients, especially those discharged on home PAP therapy.
The retrospective cohort study followed 168 patients, including 124 with COPD alone and 44 with OVS, over a median period of 20.6 months. All patients required non-invasive ventilation during their hospitalisation but only continued PAP therapy if prescribed upon discharge. At admission, the two groups had similar blood pH and carbon dioxide levels, though OVS patients presented with higher rates of hypertension and diabetes.
Results showed a median survival of 51 months for patients with OVS compared to 27.7 months for those with COPD alone. Among OVS patients, those prescribed home PAP therapy had a notably higher median survival of 59 months, while those discharged without PAP therapy had a median survival of 36.1 months. Although unadjusted analysis indicated a 43% lower mortality risk for OVS patients, this difference became less statistically significant after adjusting for multiple confounders.
The findings suggest that long-term PAP therapy may benefit COPD patients who also have OSA, potentially improving survival rates and lowering the risk of mortality. Researchers propose that early diagnosis of OSA in COPD patients and the initiation of long-term PAP therapy may be advantageous, supporting a more proactive approach to managing respiratory complications in this high-risk population.
Aleksandra Zurowska, EMJ
Reference
Nguyen BH et al. Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea. BMJ Open Respir Res. 2024;11(1):e002496.
