Cardiovascular outcomes in COPD, obstructive sleep apnoea and the overlap syndrome
6 affiliations
- 1UCL Respiratory, University College London, London, UK
- 2Royal Free Hospital NHS Foundation Trust, London, UK
- 3Institute of Health Informatics, University College London, London, UK
- 4British Heart Foundation Data Science Center, Health Data Research UK, London, UK
- 5IT:U, Linz, Austria
- 6Guys’ and St Thomas’ Hospital NHS Foundation Trust, London, UK
Abstract
Rationale: COPD and obstructive sleep apnoea (OSA) are both independently associated with an increased risk of cardiovascular disease. It is not clear whether this risk is further increased in COPD–OSA overlap. We aimed to determine whether COPD–OSA overlap has a higher cardiovascular burden compared with COPD or OSA alone.
Methods: This was a matched cohort study using electronic health records from the Clinical Practice Research Datalink Aurum database (England). Exposures of interest were a diagnosis of COPD, OSA or both based on validated code lists. Our primary outcome of interest was cardiovascular mortality defined using ICD-10 codes. Our secondary outcomes of interest included: all-cause mortality, incident acute coronary syndrome (ACS), incident stroke and incident heart failure.
Results: The initial study cohort consisted of 365 667 people with COPD (mean±sd) age 68±11 years, 59 526 with OSA age 57±11 years and 11 040 with COPD–OSA age 65±10 years. Cardiovascular mortality was significantly higher in patients with COPD–OSA overlap compared with OSA alone (adjusted hazard ratio 1.72 (1.58–1.88); p<0.001) but not compared with COPD alone. People with COPD–OSA overlap had 27% and 58% increased risk of developing ACS compared with COPD and OSA alone respectively, and 69% and 101% increased risk of developing heart failure compared with COPD and OSA respectively.
Conclusions: We have demonstrated that people with COPD–OSA overlap have a significantly higher cardiovascular burden compared with COPD or OSA alone with real-world implications. Earlier and targeted treatment with cardiovascular optimisation can potentially reduce downstream sequelae.
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BibTeX
@article{shah2026cardiovascular,
title = {{Cardiovascular outcomes in COPD, obstructive sleep apnoea and the overlap syndrome}},
author = {Amar J. Shah and Muhammad Qummer ul Arfeen and Spiros Denaxas and Natalie Fitzpatrick and Patrick Murphy and John R. Hurst and Swapna Mandal},
journal = {ERJ Open Research},
year = {2026},
month = sep,
doi = {10.1183/23120541.00419-2026},
url = {https://doi.org/10.1183/23120541.00419-2026},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cardiovascular outcomes in COPD, obstructive sleep apnoea and the overlap syndrome
AU - Amar J. Shah
AU - Muhammad Qummer ul Arfeen
AU - Spiros Denaxas
AU - Natalie Fitzpatrick
AU - Patrick Murphy
AU - John R. Hurst
AU - Swapna Mandal
PY - 2026
DA - 2026/09/01
JO - ERJ Open Research
DO - 10.1183/23120541.00419-2026
UR - https://doi.org/10.1183/23120541.00419-2026
AB - Rationale: COPD and obstructive sleep apnoea (OSA) are both independently associated with an increased risk of cardiovascular disease. It is not clear whether this risk is further increased in COPD–OSA overlap. We aimed to determine whether COPD–OSA overlap has a higher cardiovascular burden compared with COPD or OSA alone. Methods: This was a matched cohort study using electronic health records from the Clinical Practice Research Datalink Aurum database (England). Exposures of interest were a diagnosis of COPD, OSA or both based on validated code lists. Our primary outcome of interest was cardiovascular mortality defined using ICD-10 codes. Our secondary outcomes of interest included: all-cause mortality, incident acute coronary syndrome (ACS), incident stroke and incident heart failure. Results: The initial study cohort consisted of 365 667 people with COPD (mean±sd) age 68±11 years, 59 526 with OSA age 57±11 years and 11 040 with COPD–OSA age 65±10 years. Cardiovascular mortality was significantly higher in patients with COPD–OSA overlap compared with OSA alone (adjusted hazard ratio 1.72 (1.58–1.88); p<0.001) but not compared with COPD alone. People with COPD–OSA overlap had 27% and 58% increased risk of developing ACS compared with COPD and OSA alone respectively, and 69% and 101% increased risk of developing heart failure compared with COPD and OSA respectively. Conclusions: We have demonstrated that people with COPD–OSA overlap have a significantly higher cardiovascular burden compared with COPD or OSA alone with real-world implications. Earlier and targeted treatment with cardiovascular optimisation can potentially reduce downstream sequelae.
SN - 2312-0541
ER -