Right Ventricular Hemodynamics Using Cardiac MRI in Patients COPD and OSA

Despite the high prevalence of overlap syndrome, few data are available on its pathophysiology and clinical consequences of these patients. Overlap syndrome has recently been reported to have excess cardiovascular mortality compared with COPD alone. However, no study has evaluated the mechanisms of excess cardiovascular mortality in untreated overlap syndrome. In addition, no prospective, randomized, controlled data are currently available on treatment of overlap syndrome.

This study is divided into two parts. The first part (Part 1) is a cross-sectional cohort study comparing subjects with overlap syndrome to those with COPD alone and those with OSA alone. Patients with COPD and OSA overlap syndrome will be evaluated by an overnight sleep study, cardiac MRI, serum inflammatory biomarker, urine catecholamine level, pulmonary function test, and questionnaires of sleep and health related quality of life. These measurement will be compared between overlap syndrome and control groups with either COPD or OSA alone.

The second part (Part 2) of the study is a prospective, parallel-group, randomized, controlled pilot study examining the effect of BPAP (and nocturnal oxygen if needed) vs. nocturnal oxygen therapy alone in patients with overlap syndrome (20 subjects in each treatment arm). The same measurement done during Part 1 will be repeated to evaluate the treatment effects.

Inclusion criteria

• Both men and women with age more than 18 years.
• Known diagnosis of stable COPD (GOLD stage 2 or higher) or OSA.

Exclusion criteria

• Already using continuous positive airway pressure (CPAP), BPAP device, or nocturnal oxygen.
• Known or suspected renal failure with estimated Glomerular filtration (GFR) <50 ml/min/1.73 m2 or serum creatinine > 1.5 mg/dl.
• Chronic atrial fibrillation or frequent premature ventricular contraction (> 10 beats per hour)
• Women known to be pregnant or planning to be pregnant in next 6 months.
• Known contraindication to MRI: cardiac pacemaker, metallic heart valves, metallic implants, history of claustrophobia.
• If taking sildenafil or related drugs, unable to stop it within 48 hours of the study visit.
• Uncontrolled COPD or acute COPD exacerbation.
• Unstable cardiac diseases.
• Known chronic inflammatory diseases like lupus or active infection.