NICE guidance - treatments for COPD (chronic obstructive pulmonary disease) - OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

Last edited 09/2021 and last reviewed 10/2021

Lifestyle advice for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

explain to people with mild COPD-OSAHS who have no symptoms or with symptoms that do not affect usual daytime activities that:

• treatment is not usually needed and
• changes to lifestyle and sleep habits can help to prevent COPD-OSAHS from worsening
  • lifestyle advice for all severities of COPD-OSAHS
    • discuss appropriate lifestyle changes with all people with COPD-OSAHS. Provide support and information on losing weight, stopping smoking, reducing alcohol intake and improving sleep hygiene, tailored to the person's needs and in line with the NICE guidelines on:
      • stop smoking interventions and services
      • preventing excess weight gain
      • obesity: identification, assessment and management (in particular, the section on lifestyle interventions)
      • alcohol-use disorders: prevention (in particular, recommendations on screening, brief advice and extended brief interventions for adults)

Treatments for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

CPAP and non-invasive ventilation

• consider continuous positive airway pressure (CPAP) as first-line treatment for people with COPD-OSAHS overlap syndrome if they do not have severe hypercapnia (PaCO2 of 7.0 kPa or less)
• consider non-invasive ventilation instead of CPAP for people with COPD–OSAHS overlap syndrome with nocturnal hypoventilation if they have severe hypercapnia (PaCO2 greater than 7.0 kPa)
• consider heated humidification in addition to CPAP for people with COPD–OSAHS overlap syndrome and upper airway side effects such as nasal and mouth dryness, and CPAP-induced rhinitis

Oxygen therapy

• consider supplemental oxygen for people with COPD-OSAHS overlap syndrome if hypoxaemia persists once control of apnoea and nocturnal hypoventilation has been optimised by CPAP or non-invasive ventilation, and address any additional underlying causes of hypoxaemia where possible

Managing rhinitis in people with COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

• assess people with nasal congestion and COPD-OSAHS for underlying allergic or vasomotor rhinitis
• if rhinitis is diagnosed in people with COPD-OSAHS, offer initial treatment with:
  • topical nasal corticosteroids or antihistamines for allergic rhinitis or
  • topical nasal corticosteroids for vasomotor rhinitis
• for people with COPD-OSAHS and persistent rhinitis, consider referral to an ear, nose and throat specialist if:
  • symptoms do not improve with initial treatment or
  • anatomical obstruction is suspected
• be aware that:
  • rhinitis can affect people's tolerance to continuous positive airway pressure (CPAP) but changing from a nasal to an orofacial mask and adding humidification can help
  • CPAP can worsen or cause rhinitis and nasal congestion

Reference:

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