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. 2024 Jun 1;20(6):863-870.
doi: 10.5664/jcsm.11000.

The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease

Justin Rafael O De la Fuente  1 , Patricia Greenberg  2 , Jag Sunderram  3
Affiliations

The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease

Justin Rafael O De la Fuente et al. J Clin Sleep Med. .

Abstract

Study objectives: This study examined in-hospital outcomes for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as COPD-OSA overlap syndrome, during hospitalizations for acute exacerbation of COPD.

Methods: The National Inpatient Sample was used to examine in-hospital mortality, length of stay, costs, and utilization of supportive ventilation in patients with COPD-OSA overlap during acute exacerbation of COPD hospitalizations. A 1-to-1 matched case-control design was utilized to match patients with and without OSA. Multivariate logistic regression modeling was used to examine mortality and ventilatory support, while controlling for potentially confounding diagnoses.

Results: COPD-OSA overlap was associated with longer median length of stay (4 days OSA, 3 days non-OSA; P < .001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P < .001), increased utilization of noninvasive positive-pressure ventilation (13.92% OSA, 6.78% non-OSA; P < .001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P = .001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P < .001). These differences in mortality (adjusted odds ratio: 0.650; 95% confidence interval: 0.624-0.678) and noninvasive positive-pressure ventilation usage (adjusted odds ratio: 1.998; 95% confidence interval: 1.970-2.026) remained when adjusted for confounders.

Conclusions: Patients with COPD-OSA overlap have higher utilization of supportive ventilation and longer length of stay during acute exacerbation of COPD hospitalizations, contributing to higher costs. The diagnosis of OSA is associated with reduced mortality in these hospitalizations, which may be related to greater utilization of supportive ventilation when OSA is recognized.

Citation: De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med. 2024;20(6):863-870.

Keywords: COPD; COPD exacerbations; OSA; inpatient outcomes; overlap syndrome.

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Conflict of interest statement

All authors have reviewed and approved this manuscript. Work for this study was performed at Rutgers Robert Wood Johnson Medical School. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Study sample selection.
A flow diagram summarizing the study sample selection and matching process, ultimately resulting in 508,165 patients with AECOPD in the COPD-OSA overlap group and 505,682 patients within the non-OSA group. AECOPD = acute exacerbation of chronic obstructive pulmonary disease, BMI = body mass index, NIS = National Inpatient Sample, OSA = obstructive sleep apnea.
Figure 2
Figure 2. Adjusted outcomes in patients with COPD-OSA overlap syndrome.
After adjusting for concomitant diagnoses that may increase propensity to mortality and utilization of supportive ventilation, OSA was associated with higher utilization of NIPPV but reduced utilization of mechanical ventilation. OSA was also still associated with reduced mortality. ICD-10 only refers to subset analyses utilizing only ICD-10 data. CI = confidence interval, COPD = chronic obstructive pulmonary disease, ICD-10 = International Classification of Diseases, 10th Revision, NIPPV = noninvasive positive-pressure ventilation, OSA = obstructive sleep apnea.
See this image and copyright information in PMC

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