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Lung

, Volume 192, Issue 2, pp 251–258 | Cite as

Survival Benefit of CPAP Favors Hypercapnic Patients with the Overlap Syndrome

  • Philippe Jaoude
  • Thomas Kufel
  • Ali A. El-SolhEmail author
Article

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).

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.

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).

Conclusions

CPAP mitigates the excess risk of mortality in hypercapnic patients but not in normocapnic patients with the overlap syndrome.

Keywords

Overlap syndrome Continuous positive airway pressure Hypercapnia Mortality 

Notes

Acknowledgments

There was no funding support for the study. The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government.

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Philippe Jaoude
    • 1
  • Thomas Kufel
    • 1
  • Ali A. El-Solh
    • 1
    • 2
    • 3
    Email author
  1. 1.VA Western New York Healthcare SystemBuffaloUSA
  2. 2.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences and School of Public Health and Health ProfessionsState University of New York at BuffaloBuffaloUSA
  3. 3.Department of Social and Preventive Medicine, School of Medicine and Biomedical Sciences and School of Public Health and Health ProfessionsState University of New York at BuffaloBuffaloUSA

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