Obstructive Sleep Apnea (OSA) Treatment Effects on Chronic Obstructive Pulmonary Disease (COPD) outcomes

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Background: Patients with COPD who suffer from OSA as a comorbidity (overlap syndrome-OVS) have a higher risk of exacerbations, hospitalization and cardiovascular (CVD) consequences. Aims and Objectives: To investigate the effect of Positive Airway Pressure (PAP) treatment on exacerbations and hospitalization rates, incident CVD, and mortality in patients with OVS. Methods: In this prospective study, 635 COPD patients referred for OSA evaluation underwent polysomnography. Using an AHI≥ 15 for OSA diagnosis resulted in 535 patients with OVS. Multivariable regression analysis was used to investigate the effect of PAP therapy on exacerbation and hospitalization rates, incident CVD, and mortality after six years of PAP therapy, while adjusting for age, BMI, smoking, indices of OSA severity and other comorbidities. Results: 456 out of 535 patients completed the study. Of them 19% were hospitalized for CVD, 15% for COPD exacerbation and 16% died. Patients with ≥6 hours PAP showed better survival (p=0.01), lower hospitalization rates for COPD exacerbations (p=0.02), and lower CVD (p=0.04) compared to patients with <6 h use. Multiple regression analysis identified lower hours of PAP use as predictors of COPD exacerbations (HR 2.458; 95% CI 1.137–5.380; p=0.011), hospitalizations due to COPD exacerbations (HR 2.210; 95% CI 1.524–5.460; p =0.031), incident CVD (HR 1.443; 95% CI 1.119–5.143; p =0.017) and of mortality (HR 1.314; 95% CI 1.109–5.415; p =0.019). Conclusions: Our data suggests that adequate adherence to PAP therapy appears to reduce exacerbations and their severity, CVD morbidity and mortality. Further studies with are needed to confirm our findings.

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