The prevalence of overlap syndrome in obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in Medicare beneficiaries increased 4-fold from 2004 to 2013, according to a study published in Annals of the American Thoracic Society.

Using Medicare enrollment and claims data from 2004 to 2013, researchers included patients with COPD (N=141,568), 11% of whom had coexisting OSA (n=17,516). Exclusion criteria included age ≤65 years, residence in a nursing facility, or enrollment in an HMO plan. OSA diagnosis was defined as ≥1 healthcare encounter with an OSA diagnosis with a polysomnography (PSG), repeated for each year (2004-2013), and continuous positive airway pressure (CPAP) machine usage. Demographic data including age, gender, race, socioeconomic status, and region were analyzed; COPD complexity and number of comorbidities were also included.

Overlap syndrome diagnoses increased from 4.04% to 17.80% based on visits for OSA, 1.49% to 7.97% based on having a PSG, and 0.99% to 5.01%, based on having a PSG and prescription for a CPAP device. Patients with overlap syndrome were more likely to be younger, male, have higher numbers of comorbidities, and have more complex COPD than patients with COPD alone.

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Limitations as a result of the study design include usage of diagnostic coding rather than clinical laboratory testing to assess prevalence of overlap syndrome.  Generalizability to non-Medicare populations may be compromised by inclusion of fee-for-service Medicare beneficiaries. The researchers stated that when they examined the prevalence of OSA in a 5% fee-for-service non-COPD Medicare population during the same 10-year period, they “found that the overall prevalence of OSA in patients with COPD is much higher than that seen in the general population.”

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Disclosures: Dr Sharma acknowledges a relationship with Sunovion and Mylan Pharmaceuticals.


Starr P, Agarwal A, Singh G, et al. Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries [published online November 26, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201712-932RL