follow-up and monitoring for people with COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

Last edited 09/2021 and last reviewed 10/2021

Follow-up and monitoring for people with COPD (chronic obstructive pulmonary disease) - OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

Tailor follow-up to the person's overall treatment plan, which may include lifestyle changes and treating comorbidities. It may also include discussions about care planning (for example, COPD exacerbation action plan and advance care planning) for those with severe COPD.

Follow-up for people using CPAP or non-invasive ventilation

• offer face-to-face, video or phone consultations, including review of telemonitoring data (if available), to people with COPD-OSAHS overlap syndrome having non-invasive ventilation or CPAP. This should include:
  • an initial consultation within 1 month and
  • subsequent follow-up according to the person's needs and until optimal control of symptoms, apnoea-hypopnoea index (AHI) or oxygen desaturation index (ODI), oxygenation and hypercapnia is achieved
• when non-invasive ventilation or CPAP (with or without oxygen therapy) has been optimised for people with COPD-OSAHS overlap syndrome and their symptoms are controlled, consider 6-monthly to annual follow-up according to the person's needs
• offer people with COPD-OSAHS overlap syndrome having non-invasive ventilation or CPAP access to a sleep and ventilation service for advice, support and equipment between follow-up appointments

Follow-up for drivers with excessive sleepiness

• ensure follow-up is in line with Driver and Vehicle Licensing Agency guidance on assessing fitness to drive

Monitoring treatment efficacy for people with COPD-OSAHS overlap syndrome

• assess the effectiveness of treatment with CPAP or non-invasive ventilation in people with COPD–OSAHS overlap syndrome by reviewing the following:
  • symptoms of OSAHS and nocturnal hypoventilation, including the Epworth Sleepiness Scale and vigilance, for example, when driving
  • severity of OSAHS, using AHI or ODI
  • improvement in oxygenation and hypercapnia while awake and asleep
  • adherence to therapy
  • telemonitoring or download information from the device (if available)
• explore with the person their understanding and experience of treatment, and review the following:
  • mask type and fit, including checking for leaks
  • nasal and mouth dryness, and need for humidification
  • other factors affecting sleep disturbance such as insomnia, restless legs and shift work
  • sleep hygiene
  • cleaning and maintenance of equipment
• be aware that some symptoms associated with COPD such as cough and wheeze, and certain medications such as theophyllines, may adversely affect sleep quality
• for people with COPD–OSAHS overlap syndrome having supplemental oxygen therapy, review whether this is still needed after treatment with non-invasive ventilation or CPAP has been optimised
• consider stopping CPAP or non-invasive ventilation and using a symptom-management approach for people with COPD-OSAHS overlap syndrome who have severe COPD if, despite treatment optimisation, CPAP or non-invasive ventilation does not improve their symptoms or quality of life, or adds to the burden of therapy

Reference:

• NICE (August 2021). Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s