Mortality impact of long-term home NIV in COPD patients with versus without OSA

<bold>Rationale:</bold> Coexisting COPD and OSA is known as Overlap Syndrome. This condition may represent a distinct clinical phenotype, exhibiting differing characteristic responses to long-term home NIV therapy for hypercapnic chronic respiratory failure. However, current data remain scarce. <bold>Objectives:</bold> This multistate model analysis estimated the impact of home NIV therapy on transitions between three different states (without/recovery from severe exacerbation, severe exacerbation and death) in patients with Overlap Syndrome or COPD without OSA. Measurements and Main Results: Model data came from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 NIV reimbursement in 2015–2019. Outcomes in the Overlap Syndrome and COPD without OSA groups were compared using a Cox model and inverse probability of treatment weighting analysis, adjusted for baseline characteristics. Data from 54,545 patients were included (median age 70 years, 51.2% male). The probabilities of transitioning from severe exacerbation to death (10% vs. 22%) and from without severe exacerbation to death (5% vs. 18%) were lower in the Overlap Syndrome versus COPD without OSA group. The rate of transition from severe exacerbation to without exacerbation (recovery) was also higher in the Overlap Syndrome group. During NIV, the mortality rate was 33% lower in people with overlap syndrome versus COPD without OSA. <bold>Conclusion:</bold> These data suggest that people with Overlap Syndrome are likely to benefit from long-term home NIV to a greater extent than those with COPD without OSA. this finding higlights the need for OSA screening in people with COPD.