Treatment With Bilevel PAP Is Associated With a Reduction in Severe Exacerbations in COPD-OSA Overlap: A Retrospective Claims Analysis

Abstract

BACKGROUNDThere are no guidelines for obstructive sleep apnea (OSA) assessment in patients with chronic obstructive pulmonary disease (COPD). Home non-invasive ventilation (NIV) studies have excluded patients with comorbid OSA. Thus, it is unclear whether home NIV is associated with reduced exacerbation risk in patients with overlap syndrome (COPD-OSA). RESEARCH QUESTIONDoes home NIV impact the rate of severe exacerbations in patients with overlap syndrome 1 year post therapy initiation? STUDY DESIGN AND METHODSA retrospective analysis was performed on administrative claims data from patients with COPD and OSA who received a NIV device claim between 2015 and 2020. Patients were characterized 1 year before NIV initiation and 1 year after NIV initiation. A modified Poisson regression model was built to identify predictors for severe exacerbation occurrence during follow-up. RESULTSA total of 23,992 patients were included in the analysis (mean age 61.3±10.1 years, 44.9% female). The proportion of patients with ≥1 severe exacerbation was 10.2% in the year before NIV initiation and 5.9% in the year after NIV initiation (χ2 440.5, P < 0.0001). Occurrence of a severe exacerbation in the year prior to NIV was associated with a nearly 5-fold higher risk of severe exacerbation during follow-up [risk ratio 4.91; 95% confidence interval 4.39–5.48; P < 0.0001]. Heart failure, pneumonia, and anxiety were the comorbidities most associated with increased severe exacerbation risk. INTERPRETATIONThis is the first study to describe risk factors for severe exacerbations and to examine home NIV claims in this specific population. Results may be informative for overlap syndrome management, especially for preventing a first severe exacerbation and to treat OSA as part of COPD management. Additional information is needed to optimize the access, timing, and benefits of NIV treatment in patients with overlap syndrome.