Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea.

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM
Benjamin Hm Nguyen, Collette Menadue, Brendon J Yee, Olivia A McGuiness, Keith Kh Wong, Nathaniel S Marshall, Edmund Mt Lau, Amanda J Piper
{"title":"Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea.","authors":"Benjamin Hm Nguyen, Collette Menadue, Brendon J Yee, Olivia A McGuiness, Keith Kh Wong, Nathaniel S Marshall, Edmund Mt Lau, Amanda J Piper","doi":"10.1136/bmjresp-2024-002496","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Chronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with acute hypercapnic respiratory failure (ARF) is unclear.</p><p><strong>Methods: </strong>In this retrospective cohort study, 124 patients with COPD and 44 patients with OVS were treated with positive airway pressure (PAP) for ARF and followed up for a median of 20.6 months (IQR 3.80-53.4). Patients treated in the emergency or intensive care units and did not continue PAP on the wards were excluded. We compared patient characteristics and overall survival.</p><p><strong>Results: </strong>Mean (SD) age of participants was 71 (9.7) years and 51% were males. Patients with OVS had a higher prevalence of hypertension (75% vs 50.0%, p=0.004) and type 2 diabetes mellitus (45.5% vs 19.4%, p<0.001). There was no difference in arterial pH or carbon dioxide levels at presentation. On univariate analysis, mortality was lower in OVS compared with patients with COPD alone (HR 0.57, 95% CI 0.37 to 0.87). Median survival was 51.0 (95% CI 38.1 to 93.7) months in OVS and 27.7 (95% CI 16.9 to 35.1) months in COPD alone. Median survival in OVS prescribed home PAP therapy was significantly higher (59.0 months) compared with OVS not discharged on therapy (36.1 months), and to patients with COPD, irrespective of home therapy prescription (p=0.022). After adjusting for multiple known confounders, patients with OVS still appeared to have lower mortality; however, this was no longer statistically significant (HR 0.75, 95% CI 0.45 to 1.24).</p><p><strong>Discussion: </strong>We found that patients with COPD and ARF requiring non-invasive ventilation may have higher mortality rates compared with patients with OVS. Patients with OVS treated with home PAP had lower mortality compared with patients not prescribed PAP on discharge. These findings suggest that patients with COPD who present with ARF may benefit from early diagnosis of OSA and initiation of long-term PAP therapy.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499800/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002496","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with acute hypercapnic respiratory failure (ARF) is unclear.

Methods: In this retrospective cohort study, 124 patients with COPD and 44 patients with OVS were treated with positive airway pressure (PAP) for ARF and followed up for a median of 20.6 months (IQR 3.80-53.4). Patients treated in the emergency or intensive care units and did not continue PAP on the wards were excluded. We compared patient characteristics and overall survival.

Results: Mean (SD) age of participants was 71 (9.7) years and 51% were males. Patients with OVS had a higher prevalence of hypertension (75% vs 50.0%, p=0.004) and type 2 diabetes mellitus (45.5% vs 19.4%, p<0.001). There was no difference in arterial pH or carbon dioxide levels at presentation. On univariate analysis, mortality was lower in OVS compared with patients with COPD alone (HR 0.57, 95% CI 0.37 to 0.87). Median survival was 51.0 (95% CI 38.1 to 93.7) months in OVS and 27.7 (95% CI 16.9 to 35.1) months in COPD alone. Median survival in OVS prescribed home PAP therapy was significantly higher (59.0 months) compared with OVS not discharged on therapy (36.1 months), and to patients with COPD, irrespective of home therapy prescription (p=0.022). After adjusting for multiple known confounders, patients with OVS still appeared to have lower mortality; however, this was no longer statistically significant (HR 0.75, 95% CI 0.45 to 1.24).

Discussion: We found that patients with COPD and ARF requiring non-invasive ventilation may have higher mortality rates compared with patients with OVS. Patients with OVS treated with home PAP had lower mortality compared with patients not prescribed PAP on discharge. These findings suggest that patients with COPD who present with ARF may benefit from early diagnosis of OSA and initiation of long-term PAP therapy.

需要急性无创通气的慢性阻塞性肺病患者伴有和不伴有阻塞性睡眠呼吸暂停的长期死亡率。
简介:在病情稳定的门诊患者中,慢性阻塞性肺疾病(COPD)/阻塞性睡眠呼吸暂停(OSA)重叠综合征(OVS)与单纯的慢性阻塞性肺疾病相比死亡率更高。然而,急性高碳酸血症呼吸衰竭(ARF)住院患者的预后尚不明确:在这项回顾性队列研究中,124 名慢性阻塞性肺病患者和 44 名 OVS 患者接受了气道正压(PAP)治疗,随访中位数为 20.6 个月(IQR 3.80-53.4)。不包括在急诊室或重症监护室接受治疗且未在病房继续使用 PAP 的患者。我们比较了患者的特征和总生存率:参与者的平均(标清)年龄为 71(9.7)岁,51% 为男性。OVS患者的高血压(75% vs 50.0%,P=0.004)和2型糖尿病(45.5% vs 19.4%,P=0.004)发病率较高:我们发现,与 OVS 患者相比,需要无创通气的慢性阻塞性肺病和 ARF 患者的死亡率可能更高。与出院时未获处方 PAP 的患者相比,接受家用 PAP 治疗的 OVS 患者死亡率较低。这些发现表明,患有慢性阻塞性肺病并伴有 ARF 的患者可能会从早期诊断出 OSA 并开始接受长期 PAP 治疗中获益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信