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Long-Term Ventilation Linked To Improved Survival In COPD-OSA Patients

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.


Associations Of Pulmonary Microvascular Blood Volume With Per Cent Emphysema And CT Emphysema Subtypes In The Community: The MESA Lung Study

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Women With OSA Have 4 Distinct Phenotypic Patterns

Women with obstructive sleep apnea (OSA) can be categorized into 4 distinct phenotypic clusters, according to study results published in Sleep Medicine.

Previous studies have identified between 3 and 9 OSA phenotypes, depending on study characteristics. To clarify OSA phenotypes among women, researchers used data recorded between 2008 and 2023 from the European Sleep Apnoea Database (ESADA) to conduct this latent class cluster analysis. Women with 5 or more Apnea Hypopnea Index (AHI) events per hour in the ESADA cohort were evaluated for trends in demographic, clinical, and sleep characteristics.

A total of 7288 women were included in the analysis, 55.3% of whom were diagnosed by polysomnography (PSG) and 44.5% via respiratory polygraphy.

The researchers identified 4 OSA phenotypic clusters, overall. The probability of being assigned to a cluster ranged between 75% and 81%. The clusters differed significantly by 20 demographic and clinical characteristics (all P <.04) and 8 sleep characteristics (all P <05).

"

The main message of our paper is that the clinical presentation, symptoms and comorbidities of OSA are different in females. The identification of different clinical phenotypes in females may provide more efficacious, alternative treatments towards OSA management.

Cluster 1, coined "women with ischemic heart disease" was the most common OSA phenotype cluster (38.3%). The women in cluster 1 had a median age of 59 years, BMI of 30.1 kg/m2, AHI of 22.9 events per hour, and Oxygen Desaturation Index (ODI) of 18.8 events per hour. Most women were in menopause (64.3%), they had a sleep efficiency of 83.7%, 55.6% had ischemic heart disease, 44.8% had hypertension, 10.6% had asthma, 9.9% had type 2 diabetes (T2D), 3.2% chronic obstructive pulmonary disease (COPD), and 77.3% used continuous positive air pressure (CPAP).

The second most common OSA phenotype cluster (23.0%) comprised older women with comorbidities. The women in cluster 2 had a median age of 66 years, a BMI of 36 kg/m2, AHI of 46 events per hour, and ODI of 42 events per hour. Nearly all women in cluster 2 were in menopause (91.5%), they had a sleep efficiency of 79%, 78.8% had hypertension, 41.5% had T2D, 22.2% ischemic heart disease, 16.6% COPD, 12.9% had asthma, and 92.1% used CPAP.

The third most common OSA phenotype cluster (22.4%) comprised women with mild OSA and fewer comorbidities. The women in cluster 3 had a median age of 53.5 years, a BMI of 29 kg/m2, AHI of 8.6 events per hour, and ODI of 6.9 events per hour. Less than half of the women in cluster 3 were in menopause (42.9%), they had a sleep efficiency of 85.6%, 31.7% had hypertension, 12.4% had asthma, 8.3% had T2D, 3.2% COPD, 2.9% ischemic heart disease, and 23.8% used CPAP.

The least common OSA phenotype cluster (16.2%) comprised women with obesity and worse sleep. The women in cluster 4 had a median age of 49 years, BMI of 43 kg/m2, AHI of 53.3 events per hour, and ODI of 51 events per hour. Only few women in cluster 4 were in menopause (26.3%), they had a sleep efficiency of 82.1%, 48.9% had hypertension, 26% had T2D, 13.9% had asthma, 5.8% COPD, 1.9% ischemic heart disease, and 91.7% used CPAP.

The researchers concluded, "The main message of our paper is that the clinical presentation, symptoms and comorbidities of OSA are different in females. The identification of different clinical phenotypes in females may provide more efficacious, alternative treatments towards OSA management."

This study may have been limited by pooling data from different OSA diagnosis methods.

This article originally appeared on Sleep Wake Advisor





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