Annals of the American Thoracic Society · 2026
Mortality impact of long-term home non-invasive ventilation in COPD patients with versus without obstructive sleep apnea.
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Pepin Jean-Louis, Herquelot Eleonore, Denis Hélène, Patout Maxime, Josseran Anne, Lavergne Florent, Schmidt Aurélie, Malhotra Atul, Cistulli Peter A, Palot Alain, Prigent Arnaud, medXcloud group
Аннотация
RATIONALE: Coexisting chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome. This may represent a distinct clinical phenotype that shows different responses after being initiated on noninvasive ventilation (NIV) for hypercapnic chronic respiratory failure. However, current data remain scarce.
OBJECTIVE(S): This study estimated the impact of overlap syndrome versus COPD without OSA on transitions between 3 states (without/recovery from severe exacerbation, severe exacerbation and death) in patients initiated on domiciliary NIV therapy.
METHODS: Multistate model data came from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 NIV reimbursement in 2015-2019. Outcomes in the overlap syndrome and COPD without OSA groups were compared using a Cox model and inverse probability of treatment weighting analysis, adjusted for patient characteristics.
RESULTS: Data from 54,545 patients were included (median age 70 years, 51.2% male). Probabilities of transitioning from severe exacerbation to death (10% vs. 22%) and without severe exacerbation to death (5% vs. 18%) were lower in the overlap syndrome versus COPD without OSA group. The rate of transition from severe exacerbation to without exacerbation/recovery was also higher in the overlap syndrome group. After NIV initiation, the mortality rate was 33% lower in people with overlap syndrome vs COPD without OSA.
CONCLUSIONS: For people with COPD started on domiciliary NIV, those with overlap syndrome might benefit from NIV to a greater extent than those without OSA. This highlights the need for OSA screening in people with COPD.
OBJECTIVE(S): This study estimated the impact of overlap syndrome versus COPD without OSA on transitions between 3 states (without/recovery from severe exacerbation, severe exacerbation and death) in patients initiated on domiciliary NIV therapy.
METHODS: Multistate model data came from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 NIV reimbursement in 2015-2019. Outcomes in the overlap syndrome and COPD without OSA groups were compared using a Cox model and inverse probability of treatment weighting analysis, adjusted for patient characteristics.
RESULTS: Data from 54,545 patients were included (median age 70 years, 51.2% male). Probabilities of transitioning from severe exacerbation to death (10% vs. 22%) and without severe exacerbation to death (5% vs. 18%) were lower in the overlap syndrome versus COPD without OSA group. The rate of transition from severe exacerbation to without exacerbation/recovery was also higher in the overlap syndrome group. After NIV initiation, the mortality rate was 33% lower in people with overlap syndrome vs COPD without OSA.
CONCLUSIONS: For people with COPD started on domiciliary NIV, those with overlap syndrome might benefit from NIV to a greater extent than those without OSA. This highlights the need for OSA screening in people with COPD.