Symptomatic response to CPAP in obstructive sleep apnea versus COPD- obstructive sleep apnea overlap syndrome: Insights from a large national registry

Abstract

Background The symptomatic response to continuous positive airway pressure (CPAP) therapy in COPD-obstructive sleep apnea overlap syndrome (OVS) compared to OSA syndrome (OSA) alone has not been well studied so far. The aim of this study is to explore main differences in the clinical response to CPAP treatment in OVS compared to OSA alone. Study design and methods Using prospective data from the French National Sleep Apnea Registry, we conducted an observational study among 6320 patients with moderate-to-severe OSA, available spirometry, and at least one follow-up visit under CPAP therapy. Results CPAP efficacy measured on the residual apnea-hypopnea index and median adherence were similar between OVS and OSA patients. In both groups, the overall burden of symptoms related to sleep apnea improved with CPAP treatment. In a multivariable model adjusted for age, gender, body mass index, adherence to treatment and residual apnea-hypopnea index, OVS was associated with higher odds for persistent morning headaches (OR: 1.37 [95% CI; 1.04; 1.79]; P = 0.02), morning tiredness (OR: 1.33 [95% CI: 1.12; 1.59]; P<0.01), daytime sleepiness (OR; 1.24 [95% CI: 1.4; 1.46]: P<0.01) and exertional dyspnea (OR: 1.26 [95% CI: 1.00;1.58]; P = 0.04) when compared with OSA alone. Interpretation CPAP therapy was effective in normalizing the apnea-hypopnea index and significantly improved OSA-related symptoms, regardless of COPD status. CPAP should be offered to patients with OVS on a trial basis as a significant improvement in OSA-related symptoms can be expected, although the range of response may be less dramatic than in OSA alone.

Prevalence and Characteristics of Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: Overlap Syndrome

“…Another important finding from our study is that patients in the OVS group were more likely to have comorbidities like hypertension and cardiovascular disease. This finding aligns with prior research, which suggests that OVS patients experience a higher burden of comorbidities, particularly cardiovascular ones, compared to those with only OSA or COPD [55]. While the impact of OVS on cardiovascular outcomes varied across different studies and remains uncertain [9,16,38,42,43,53,61,62,[66][67][68][69][70][71][72][73][74][75][76][77][78], our study found that patients in the OVS group were linked to a 1.3-fold higher risk of developing hypertension and cardiovascular disease.…”

“…Available data indicate a higher prevalence of depression in OVS patients compared to those with pure COPD [52,53] but a similar prevalence compared to patients with OSA alone [9,42,54]. On the other hand, CPAP treatment has proven to be effective in reducing depression and enhancing the quality of life in individuals with OVS and OSA [55,56]. Therefore, it is crucial to promptly identify depression and provide appropriate treatment for patients with OVS, considering the potential negative impact of unrecognized and untreated depression on them, which can lead to increased fatigue and the greater utilization of healthcare resources [57][58][59].…”

The Overlap Syndrome of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: A Systematic Review

“…Among OSA patients with available spirometry results, the coexistence of COPD was confirmed in 11.9-23.2% [33,44,47,48,62].…”

National Knowledge-Driven Management of Obstructive Sleep Apnea—The Swedish Approach

“…To align the process of OSA treatment, we developed the shared decision matrix. OSA treatment, for example, with PAP, improves a variety of daytime and sleep related symptoms irrespective of patients age and AHI at baseline [ 27 ]. This implicates a strong indication for treatment (moderate to very strong) in symptomatic OSA patients, in particular, as treatment options such as PAP and MAD are safe.…”