Impact of CPAP Use and Age on Mortality in Patients with Combined COPD and Obstructive Sleep Apnea: The Overlap Syndrome
Impact of CPAP Use and Age on Mortality in Patients with Combined COPD and Obstructive Sleep Apnea: The Overlap Syndrome
复制标题
DOI：
10.5664/jcsm.2916
复制
发表时间：
2013-01-01
影响因子：
4.3
通讯作者：
Malhotra, Atul
中科院分区：
文献类型：
--
作者：
Stanchina, Michael L.;Welicky, Lauren M.;Malhotra, Atul
背景：重叠综合征是由慢性阻塞性肺疾病(COPD)和阻塞性睡眠呼吸暂停(OSA)同时存在定义的，与不良预后相关。从一个大的门诊队列中，我们的目标是更好地定义重叠综合征死亡率增加的危险因素，并假设坚持CPAP将与重叠综合征患者的生存改善相关。方法：从2007-2010年10,272名患者的门诊数据库中进行特殊分析，确定3,396名患者，分为6组；既有活着的患者，也有死亡的患者，已知诊断为COPD、OSA以及COPD+OSA的重叠。收集有关他们的性别、年龄、肺功能、阻塞性睡眠呼吸暂停参数和CPAP依从性的信息。结果：1 112例COPD患者和2 284例阻塞性睡眠呼吸暂停综合征(OSA)患者通过诊断编码和综合图表回顾确定。在这些患者中，227名患者被确认为重叠综合征。死亡17例(7.4%)。多变量分析显示，持续机械通气时间和年龄是死亡率的独立预测因素(HR0.71和1.14p<；0.001，0.002)。使用CPAP的时间越长，死亡率越低；尽管年龄与使用CPAP无关(p=0.2)，但使用CPAP+2小时的患者的平均年龄显著高于使用CPAP+2小时的患者。结论：从这个观察队列来看，重叠综合征的死亡率受使用CPAP的影响。年龄也是一个独立因素，与生存期和CPAP使用率呈负相关。
Background: The overlap syndrome, defined by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to define better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome.Methods: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identified 3,396 patients which were classified in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA. Information regarding their gender, age, pulmonary function, obstructive sleep apnea parameters, and CPAP compliance was collected. A multivariate Cox proportional hazards model was generated for the determinants of mortality.Results: 1,112 COPD patients and 2,284 OSA patients were identified by diagnostic coding and then comprehensive chart review. Of these, 227 patients were identified with the overlap syndrome. From this group, 17 patients (7.4%) died. Multivariate analysis revealed hours of CPAP use and age as independent predictors of mortality (HR 0.71 and 1.14, p < 0.001, 0.002). Greater time on CPAP was associated with reduced mortality; although age did not correlate with CPAP use (p = 0.2), mean age of those with CPAP use < 2 hours per night was significantly higher than those using CPAP > 2 hours per night.Conclusions: From this observational cohort, mortality in the overlap syndrome is impacted by CPAP use. Age is also an independent factor which has a negative association with survival and CPAP usage.