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Fixed-pressure nCPAP in patients with obstructive sleep apnea (OSA) syndrome and chronic obstructive pulmonary disease (COPD): a 24-month follow-up study

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Abstract

Purpose

The aim of this study was to investigate the time course of body weight, daytime sleepiness, and functional cardiorespiratory parameters in patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA), after institution of domiciliary nasal continuous positive airway pressure (nCPAP).

Methods

Twelve consecutive obese outpatients (mean age = 61 ± 11 years; four women) were evaluated before (baseline) and after 3, 12, and 24 months of nocturnal nCPAP (4 h per night).

Results

At baseline, all patients were hypercapnic and hypoxemic, suffering from night desaturation (T 90 is the percentage of total recording time (TRT) spent with SaO2 ≤ 90% = 38 ± 2%) and sleepy (Epworth sleepiness scale [ESS] = 16.58 ± 0.86). Three months after the implementation of nCPAP, daytime PaCO2 and PaO2 improved up to 45.1 ± 0.9 and 69.0 ± 1 mmHg, respectively; mean pulmonary artery pressure (MPAP) decreased from 24.7 ± 1.1 to 19.2 ± 04 mmHg. All other variables showed progressive improvements up to 12 months. At 3 and 12 months, mean body mass index was slightly decreased (to 31.6 ± 0.2 and 30.7 ± 0.1 kg/m2, respectively); daytime sleepiness, nocturnal O2 desaturation, and maximal inspiratory pressure were also improved and thereafter remained stable.

Conclusions

In conclusion, in our patients with both severe OSA and mild-to-moderate COPD, arterial blood gasses and MPAP improved and stabilized after 3 months of nCPAP therapy, with the greatest improvements being in ESS score, T 90, and maximal inspiratory force from 3 up to 12 months; these parameters remained stable over the following 12 months. Finally, our data support early treatment with nCPAP in such patients.

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Abbreviations

AHI:

apnea–hypopnea index

AECOPD:

acute exacerbations of COPD

BMI (kg/m2):

body mass index

COPD:

chronic obstructive pulmonary disease

DE:

Doppler echocardiography

ESS:

Epworth sleepiness scale

FEV1%:

forced expiratory volume in 1 s

FVC%:

forced vital capacity

FRC%:

functional residual capacity

MPAP (mmHg):

mean pulmonary artery pressure

MSaO2%:

mean nocturnal SaO2

Pimax :

maximal inspiratory pressure

nCPAP:

nasal continuous positive airway pressure

NPPV:

noninvasive positive pressure ventilation

NIV:

noninvasive mechanical ventilation

NSaO2%:

nadir nocturnal SaO2

OSA:

obstructive sleep apnea syndrome

OSA + COPD:

overlap syndrome

PaCO2 (mmHg):

arterial carbon dioxide tension

PaO2 (mmHg):

arterial oxygen partial pressure

RHC:

right heart catheterization

SaO2%:

arterial oxygen saturation

TRT%:

total recording time

T90%:

percentage of TRT spent with SaO2 ≤90%

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Authors and Affiliations

  1. “A. Galateo” Lung Disease Hospital, Third Division ASL/Lecce, San Cesario di Lecce, Lecce, Italy

    Domenico Maurizio Toraldo

  2. Laboratory of Human Anatomy, Department of Biological and Environmental Sciences and Technologies, University of Salento, via prov.le Lecce-Monteroni, 73100, Lecce, Italy

    Francesco De Nuccio & Giuseppe Nicolardi

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  1. Domenico Maurizio Toraldo
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  2. Francesco De Nuccio
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  3. Giuseppe Nicolardi
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Correspondence to Domenico Maurizio Toraldo.

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Toraldo, D.M., De Nuccio, F. & Nicolardi, G. Fixed-pressure nCPAP in patients with obstructive sleep apnea (OSA) syndrome and chronic obstructive pulmonary disease (COPD): a 24-month follow-up study. Sleep Breath 14, 115–123 (2010). https://doi.org/10.1007/s11325-009-0291-1

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