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Survival benefit of CPAP favors hypercapnic patients with the overlap syndrome.
- Source :
-
Lung [Lung] 2014 Apr; Vol. 192 (2), pp. 251-8. Date of Electronic Publication: 2014 Jan 23. - Publication Year :
- 2014
-
Abstract
- Background: Patients with the combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), known as the "overlap syndrome," have a substantially greater risk of morbidity and mortality compared to those with either COPD or OSA alone. The study's objective was to report on the long-term outcome of hypercapnic (PaCO2 ≥ 45 mmHg) and normocapnic patients with the overlap syndrome treated with continuous positive airway pressure (CPAP).<br />Methods: A nonconcurrent cohort of consecutive patients with the overlap syndrome was followed for a median duration of 71 months (range 1-100) at a VA sleep center. All patients were managed according to the prevailing recommendations of both diseases. The end point of the study was all-cause mortality.<br />Results: Of the 271 patients identified, 104 were hypercapnic (PaCO2 = 51.6 ± 4.3 mmHg). Both normocapnic and hypercapnic patients had comparable apnea-hypopnea indexes (AHI) (29.2 ± 23.8 and 35.2 ± 29.2/h, respectively; p = 0.07) and similar adherence rates to CPAP (43 and 42 %, respectively, p = 0.9). Survival analysis revealed that hypercapnic patients who were adherent to CPAP had reduced mortality compared to nonadherent hypercapnic patients (p = 0.04). In contrast, the cumulative mortality rate for normocapnic patients was not significantly different between the adherent and the nonadherent group (p = 0.42). In multivariate analysis, the comorbidity index was the only independent predictor of mortality in normocapnic patients with the overlap syndrome [hazard ratio (HR) 1.68; p < 0.001] while CPAP adherence was associated with improved survival (HR 0.65; p = 0.04).<br />Conclusions: CPAP mitigates the excess risk of mortality in hypercapnic patients but not in normocapnic patients with the overlap syndrome.
- Subjects :
- Aged
Female
Humans
Hypercapnia complications
Hypercapnia diagnosis
Hypercapnia mortality
Kaplan-Meier Estimate
Male
Middle Aged
New York
Patient Compliance
Proportional Hazards Models
Pulmonary Disease, Chronic Obstructive complications
Pulmonary Disease, Chronic Obstructive diagnosis
Pulmonary Disease, Chronic Obstructive mortality
Retrospective Studies
Risk Factors
Sleep Apnea, Obstructive complications
Sleep Apnea, Obstructive diagnosis
Sleep Apnea, Obstructive mortality
Syndrome
Time Factors
Treatment Outcome
Veterans Health
Continuous Positive Airway Pressure adverse effects
Continuous Positive Airway Pressure mortality
Hypercapnia therapy
Pulmonary Disease, Chronic Obstructive therapy
Sleep Apnea, Obstructive therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1750
- Volume :
- 192
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Lung
- Publication Type :
- Academic Journal
- Accession number :
- 24452812
- Full Text :
- https://doi.org/10.1007/s00408-014-9555-z