Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans With Chronic Obstructive Pulmonary Disease and Comorbid Obstructive Sleep Apnea (Overlap Syndrome)

Inclusion Criteria:

• OSA with moderate-to-severe disease, AHI 20 per hour by in-lab polysomnography withconcomitant moderate-severe COPD based on pulmonary function tests (PFTS) and withpast significant history (>10 pack-years) of smoking

• Male or female gender

• Age greater than or equal to 60 years

• Stable treatment regimen for COPD

Exclusion Criteria:

• Current or prior treatment with PAP or oral appliance

• Central sleep apnea defined as central apnea index >5 per hour and comprising 50% ofAHI

• Known primary neuromuscular diseases

• Disorders that may impact cognitive function including:

• neurodegenerative disorders

• traumatic brain injury

• untreated PTSD and/or history of learning disability

• Medicines that may cause or alter sleepiness: sedative hypnotics, or stimulants asthese may alter the results

• Patient is actively suicidal due to depression, unstable mental health condition

• Epworth sleepiness score >16 (severe sleepiness) or a near-miss or prior automobileaccident due to sleepiness within the past 12 months

• Narcolepsy is the primary sleep disorder, with requirement of stimulant medications

• Employed as a commercial driver or operating heavy machinery

• On long-term oxygen therapy prior to start of study, more than 12 hr/day

• Patients is unable to use either a nasal or face mask (e.g., facial trauma,claustrophobia)

• Consumption of >3 alcoholic beverages per day or current use of some illicit drugs,as these may contribute to cognitive deficits

• Patients who cannot give informed consent

• Patients receiving hospice care

• Pregnant women due to unknown risks