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 (AECOPD).
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 AECOPD hospitalizations. A one-to-one 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<0.001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P<0.001), increased utilization of non-invasive positive pressure ventilation (NIPPV) (13.92% OSA, 6.78% non-OSA; P<0.001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P=0.001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P<0.001). These differences in mortality (adjusted OR: 0.650; 95% CI 0.624 - 0.678) and NIPPV usage (adjusted OR: 1.998; 95% CI 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 AECOPD 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.
Keywords: COPD; COPD exacerbations; OSA; inpatient outcomes; overlap syndrome.
© 2024 American Academy of Sleep Medicine.