Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome.

RATIONALE: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) (overlap syndrome) are more likely to develop pulmonary hypertension than patients with either condition alone. OBJECTIVES: To assess the relation of overlap syndrome to mortality and first-time hospitalization because of COPD exacerbation and the effect of continuous positive airway pressure (CPAP) on these major outcomes. METHODS: We included 228 patients with overlap syndrome treated with CPAP, 213 patients with overlap syndrome not treated with CPAP, and 210 patients with COPD without OSA. All were free of heart failure, myocardial infarction, or stroke. Median follow-up was 9.4 years (range, 3.3-12.7). End points were all-cause mortality and first-time COPD exacerbation leading to hospitalization. MEASUREMENTS AND MAIN RESULTS: After adjustment for age, sex, body mass index, smoking status, alcohol consumption, comorbidities, severity of COPD, apnea-hypopnea index, and daytime sleepiness, patients with overlap syndrome not treated with CPAP had a higher mortality (relative risk, 1.79; 95% confidence interval, 1.16-2.77) and were more likely to suffer a severe COPD exacerbation leading to hospitalization (relative risk, 1.70; 95% confidence interval, 1.21-2.38) versus the COPD-only group. Patients with overlap syndrome treated with CPAP had no increased risk for either outcome compared with patients with COPD-only. CONCLUSIONS: The overlap syndrome is associated with an increased risk of death and hospitalization because of COPD exacerbation. CPAP treatment was associated with improved survival and decreased hospitalizations in patients with overlap syndrome.

EPOC y síndrome de apnea-hipopnea del sueño / COPD and sleep apnea-hypopnea syndrome

Se ha dado en llamar síndrome de overlap a la coexistencia en un mismo paciente con enfermedadpulmonar obstructiva crónica (EPOC) de apnea-hipopnea obstructiva durante el sueño. La prevalencia deesta entidad se calcula en un 1% de la población adulta. Sin que haya una presentación clínica característica,los pacientes con overlap presentan una EPOC con un grado desproporcionado de hipoxemia, hipercapnia ydisnea. Suelen referir roncopatía, mala calidad de sueño y somnolencia diurna. Hay una rápida tendencia adesarrollar hipertensión pulmonar. La historia natural del proceso es poco conocida, pero del estudio deCohorte Observacional del Sueño de Zaragoza se deduce un aumento de mortalidad secundaria a episodioscardiovasculares a largo plazo en pacientes no tratados con ventilación no-invasiva. El tratamiento delsíndrome de overlap es el propio de los 2 componentes y, por tanto, debe optimizarse el tratamientoindividualizado de la EPOC y evaluar la gravedad del trastorno respiratorio del sueño y su respuesta altratamiento específi co con ventilación no invasiva(AU)

Overlap syndrome refers to the coexistence of COPD and obstructive sleep apneas-hypopneas in the samepatient. This syndrome affects 1% of the adult population. There is no particular clinical presentation butpatients with overlap syndrome show COPD with disproportionate hypercapnia, hypoxemia and dyspnea.These patients usually report loud snoring, poor quality of sleep and daytime drowsiness. There is also atendency to rapidly develop pulmonary hypertension. The natural history of the syndrome is largely unknownbut some preliminary results from the Zaragoza Sleep Cohort Study indicate a high probability of long-termcardiovascular mortality in patients with overlap syndrome not treated with non-invasive ventilation.Treatment of the syndrome is nonspecifi c. The treatment of overlap syndrome is specifi c to each of the twocomponents and consequently the management of COPD should be individually tailored and the severity ofobstructive sleep apnea-hypopnea syndrome and response to non-invasive ventilation should be evaluated(AU)

[COPD and sleep apnea-hypopnea syndrome]. / EPOC y síndrome de apnea-hipopnea del sueño.

Overlap syndrome refers to the coexistence of COPD and obstructive sleep apneas-hypopneas in the same patient. This syndrome affects 1% of the adult population. There is no particular clinical presentation but patients with overlap syndrome show COPD with disproportionate hypercapnia, hypoxemia and dyspnea. These patients usually report loud snoring, poor quality of sleep and daytime drowsiness. There is also a tendency to rapidly develop pulmonary hypertension. The natural history of the syndrome is largely unknown but some preliminary results from the Zaragoza Sleep Cohort Study indicate a high probability of long-term cardiovascular mortality in patients with overlap syndrome not treated with non-invasive ventilation. Treatment of the syndrome is nonspecific. The treatment of overlap syndrome is specific to each of the two components and consequently the management of COPD should be individually tailored and the severity of obstructive sleep apnea-hypopnea syndrome and response to non-invasive ventilation should be evaluated.