Mortality Impact of Long-Term Home Non-Invasive Ventilation in COPD Patients with Versus without Obstructive Sleep Apnea

Abstract 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 non-invasive 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 three 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 versus 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. Funding This study was funded by Resmed. JLP is supported by the French National Research Agency (ANR) in the framework of the "FRANCE 2030” program, the “e-health and integrated care” chair of Grenoble Alpes University Foundation and “Sleep Health-AI chair” in “MIAI Cluster” of artificial intelligence (ANR-23-IACL-0006).