Chronic obstructive pulmonary disease (COPD) is a risk factor for death in patients admitted to intensive care units (ICUs) for respiratory support. Previous reports suggested higher mortality in COPD patients with COVID-19. It is yet unknown whether patients with COPD were treated differently compared to non-COPD patients. We compared the ventilation management and outcomes of invasive ventilation for COVID-19 in COPD patients versus non-COPD patients. This was a post hoc analysis of a nation-wide, observational study in the Netherlands. COPD patients were compared to non-COPD patients with respect to key ventilation parameters. The secondary endpoints included adjunctive treatments for refractory hypoxemia, and 28-day mortality. Of a total of 1090 patients, 88 (8.1%) were classified as having COPD. The ventilation parameters were not different between COPD patients and non-COPD patients, except for FiO₂, which was higher in COPD patients. Prone positioning was applied more often in COPD patients. COPD patients had higher 28-day mortality than non-COPD patients. COPD had an independent association with 28-day mortality. In this cohort of patients who received invasive ventilation for COVID-19, only FiO₂ settings and the use of prone positioning were different between COPD patients and non-COPD patients. COPD patients had higher mortality than non-COPD patients.

Background: Noninvasive ventilation (NIV) is a cornerstone of respiratory management in patients with various chronic conditions. While a follow‐up polysomnography (PSG) is recommended to optimize ventilatory support, its utility and outcome data are limited. This study aimed to describe problems identified during the follow‐up PSG and subsequent ventilator setting adjustments in this population.Methods: The follow‐up titration PSGs of patients prescribed with ambulatory NIV between January 2022 and January 2024 were retrospectively reviewed. Mixed effects logistic regression models were used to identify factors associated with setting changes.Results: Two hundred ninety‐seven PSGs from 106 patients (median age 15.9 years) were included in the analysis, including 216 titration and 81 baseline studies. Fifty percent of patients were diagnosed with neuromuscular diseases. The most common code of NIV was 77.4% on BPAP‐ST, followed by PC‐SIMV (14.2%) and PCV mode (8.5%). 81.5% of the titration studies resulted in ventilator setting adjustments. The most common problems identified were residual respiratory events, inadequate ventilation and significant leaks. The lower home IPAP setting and higher BMI were associated with increased odds of ventilator setting adjustment, with odds ratio of 0.86 (95% CI: 0.76, 0.98; p‐value 0.021) and 1.02 (95% CI: 1.00, 1.03; p‐value 0.017), respectively.Conclusion: Follow‐up PSG frequently results in ventilator setting adjustments in patients with ambulatory NIV. Patients with lower IPAP setting and higher BMI are more likely to have changes in ventilator setting after PSG. The facility involving the care of ambulatory NIV patients should be familiar with the common problems found in PSGs.

Obstructive sleep apnea (OSA) could increase pulmonary artery pressure. However, the clinical consequences vary, mainly depending on comorbidities. Patients with pulmonary hypertension associated with lung diseases (World Health Organization (WHO) Group 3 pulmonary hypertension) are particularly vulnerable increases in pulmonary artery pressure. Managing pulmonary hypertension in this specific patient population presents a considerable challenge. While positive airway pressure therapy for OSA has shown promise in improving pulmonary hemodynamics in patients with obesity hypoventilation syndrome and chronic obstructive pulmonary disease, evidence is lacking for similar improvements in those with other pulmonary diseases and hypoventilation disorders. Furthermore, pulmonary-artery-specific therapies may carry a risk of clinical worsening in this group. Weight management and new pharmacotherapy have together emerged as a crucial intervention, demonstrating benefits for both OSA and pulmonary hemodynamics. We reviewed key studies that provide insights into the influence of OSA on WHO Group 3 pulmonary hypertension and the clinical management of both conditions.

Study objectives: Nocturnal hypertension is common in patients with obstructive sleep apnea (OSA) and contributes to elevated cardiovascular risk. Pulse transit time (PTT) offers a noninvasive method to estimate nocturnal blood pressure (BP) during sleep, but its clinical validity in OSA remains unclear. This study aimed to assess the correlation between PTT-derived nocturnal BP (PTT-BP) and 24-hour ambulatory BP monitoring (ABPM-BP) in patients with suspected OSA. Methods: Adults undergoing full-night PSG for suspected OSA were prospectively enrolled and underwent 24-hour ABPM the following day. Nocturnal hypertension was defined as mean nighttime BP ≥ 120/70 mmHg. Exclusion criteria included positive airway pressure titration, arrhythmias affecting PTT accuracy, and incomplete ABPM data. PTT-BP and ABPM-BP were compared across OSA severity levels. Results: Sixty-six subjects (median age 47 years; 39.4% male) were analyzed. Prior hypertension was reported in 40.9%. OSA severity was mild in 28.8%, moderate in 37.9%, and severe in 28.8%. PTT-BP demonstrated a weak correlation with nocturnal ABPM-BP. Among patients with mild OSA, nocturnal PTT- BP was comparable to ABPM-BP. However, among patients with moderate to severe OSA, both systolic and diastolic PTT-BP exceeded ABPM-BP. Sensitivity and specificity of PTT-SBP ≥ 104 mmHg in detecting nocturnal hypertension were 85% and 39%, respectively. PTT-SBP ≥ 104 mmHg identified masked hypertension with 78% sensitivity and 48% specificity. Conclusions: PTT-derived BP tends to overestimate nocturnal BP in patients with moderate to severe OSA. The exact value from PTT can be significantly different from ambulatory blood pressure monitoring, which affects reliability. However, PTT-derived systolic BP may be useful in screening for nocturnal and masked hypertension.