Overlap Syndrome in COPD and OSA Is Up 4-Fold in Medicare Beneficiaries

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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.
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.

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.

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.”

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

Reference

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

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