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The combination of COPD and obstructive sleep apnea (OSA) can lead to undesirable interactions with the treatment approach. The investigators know that continuous positive airway pressure (CPAP) can increase dynamic hyperinflation in COPD patients, and in mechanical ventilation, the increase in PEEP can worsen dynamic hyperinflation. On the other hand, the team know that the severity of COPD obstruction and hyperinflation alter sleep efficiency, with periods of wakefulness during sleep, and during these periods, the patient would not have upper airway obstruction, which could affect the therapy they are receiving in CPAP mode for OSA. Moreover, it was observed that with greater hyperinflation, the rate of obstructive events decreases, dynamically affecting the ventilatory situation with upper airway resistance. Recent studies have determined the safety and efficacy of auto-adjusting systems in the treatment of overlap syndrome, which could be more adaptable to the changing pulmonary mechanics of these patients. Aerobic capacity is a good predictor to the health status in these patients and the investigators know it is reduced in patients with AOS, where CPAP treatment according to studies improves the peak VO2. Therefore, the objective is to compare a ventilation system with fixed pressures established through polysomnography in patients with overlap syndrome and dynamic hyperinflation to a dynamic ventilation system using the fixed pressure limits typically established, based on their impact on the aerobic capacity (peak VO2) of these patients after 1 month of treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FIXED PRESSURE | Experimental | Home nocturnal therapy either at the fixed pressure obtained in the polysomnography for 28 days |
|
| B | Active Comparator | Dynamic pressure in Dreamstation AVAPS-AAM PhilipsRespironic® mode for 28 days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fixed pressure obtained in the polysomnography for 28 days | Procedure | home nocturnal therapy either at the fixed pressure obtained in the polysomnography for 28 days |
|
| Measure | Description | Time Frame |
|---|---|---|
| Peak VO2 | Peak VO2 as the primary variable obtained from cycle ergometry. | 0,29 and 57 days. |
| Measure | Description | Time Frame |
|---|---|---|
| VO2 max | VO2 max as a secondary variable obtained from cycle ergometry | 0,29 and 57 days. |
| Anaerobic threshold | Anaerobic threshold as a secondary variable obtained from cycle ergometry. |
| Measure | Description | Time Frame |
|---|---|---|
| Epworth scale | Based on a scale of (0 to 24 points) | 0,29 and 57 days. |
| Analytical parameters | CAT u/ml | 0,29 and 57 days. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Herminia Buchelli Ramirez Servicio de Neumología. Hospital Universitario Virgen de la Ar, MD | Contact | TFL: 968369500. | Exts 369422/36 | fjose.ruiz1@um.es |
| Francisco José Ruiz López Servicio de Neumología. Hospital Universitario Virgen de la Ar, MD | Contact | 968369500 | Exts 369422/36 | fjose.ruiz1@um.es |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Servicio de Neumología. Hospital Universitario Virgen de la Arrixaca. | Murcia | Murcia | 30120 | Spain |
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| Dynamic pressure in Dreamstation AVAPS-AAM PhilipsRespironic® mode | Procedure | dynamic pressure in Dreamstation AVAPS-AAM PhilipsRespironic® mode (program B) for 28 days, using the apnea threshold obtained in the titration as the maximum EPAP pressure and adjusting the support pressure for inferred Vt to 8 ml/kg of ideal body weight. After the first 28 days, a polysomnography will be performed under therapy with the device, and the next morning, cycle ergometry will be conducted. |
|
| 0,29 and 57 days. |
| VE/VCO2 | The slope of VE/VCO2 obtained from cycle ergometry and resting PEtCO2. | 0,29 and 57 days. |
| BODE INDEX. (body mass index,) | Polysomnography | 0,29 and 57 days. |
| BODE INDEX. ( air-flow obstruction) | Time in hypoventilation period both during wakefulness and sleep, and as a function of total sleep time. | 0,29 and 57 days. |
| BODE INDEX. (dyspnea, ) | number of residual respiratory events, time in hypoventilation period both during wakefulness and sleep, and as a function of total sleep time. | 0,29 and 57 days. |
| BODE INDEX. (exercise capacity) | 0,29 and 57 days. |
| Analytical parameters | ProBNP pg/mL | 0,29 and 57 days. |
| Analytical parameters | C-reactive protein mg/dL | 0,29 and 57 days. |
| Analytical parameters | pH | 0,29 and 57 days. |
| Analytical parameters | pO2 mmHg, pCO2 mmHg | 0,29 and 57 days. |
| Analytical parameters | sHCO3 mmol/L | 0,29 and 57 days. |
| Analytical parameters | SatO2 % | 0,29 and 57 days. |
| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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