Positive Airway Pressure for Overlap Syndrome in Older Veterans

This study is looking at how positive airway pressure (PAP) therapy affects older Veterans (age 60 and above) who have both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), a combination known as Overlap Syndrome (OVS). Researchers want to see if PAP therapy can improve sleep, thinking abilities, and overall quality of life for these individuals. Participants will either receive PAP therapy, which involves using a device to help with breathing, or conservative care, which includes education about sleep apnea and sleep hygiene. The study aims to enroll 668 participants and will measure changes in thinking abilities at 3 and 6 months to see if the treatment is successful.

Study design
This is an interventional study that will randomize 668 participants to either receive positive airway pressure therapy or conservative care. The study aims to compare the effectiveness of these two approaches.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
Participants' neurocognitive function will be measured at 3 and 6 months after the start of the study.

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NCT04179981

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

Recruiting
NAAges 60+InterventionalTreatment
VA Office of Research and Development
~668 participants
Updated 2026-06-05 on ClinicalTrials.gov
What's tested:Positive airway pressureConservative care (control arm)

At a glance

Recruiting sites
1 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Neurocognitive function Trails A and Trails B
Measured over Change from baseline at 3 and 6 months
+12 more outcomes measured
Sleep Apnea Syndrome
Obstructive Sleep Apnea
COPD
Overlap Syndrome
Quality of Life
Neurocognitive Function
Sleepiness
Elderly
Positive Airway Pressure
1 sites across 1 states
Michigan1
  • Susmita Chowdhuri, MD MS · PRINCIPAL_INVESTIGATOR · John D. Dingell VA Medical Center, Detroit, MI

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Eligibility criteria

Inclusion

OSA with moderate-to-severe disease, AHI 20 per hour by in-lab polysomnography with concomitant moderate-severe COPD based on pulmonary function tests (PFTS) and with past 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

Current or prior treatment with PAP or oral appliance
Central sleep apnea defined as central apnea index \>5 per hour and comprising 50% of AHI
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 as these 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 automobile accident 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
  • Neurocognitive function Trails A and Trails BChange from baseline at 3 and 6 months

    Trails A and Trails B test will be administered to evaluate attention and psychomotor function. This score is adjusted for age, race, gender, and years of education. Scored on a Standard scale of 100 +/- 15 for normal ranges, above 115 is above average, below 85 is considered below average.

  • Neurocognitive function PASATChange from baseline at 3 and 6 months

    PASAT (Paced Auditory Serial Addition Test) will be administered to evaluate vigilance and executive function. The PASAT is recorded as the total number of correct responses (from 0-60), or the percent of correct responses out of 60 (from 0-100), where a higher value is a better outcome.

  • Neurocognitive function Stroop color-word interferenceChange from baseline at 3 and 6 months

    Stroop color-word interference test will be administered to evaluate executive function. This score is adjusted for age, and years of education. Scored on a Standard scale of 100 +/- 15 for normal ranges, above 115 is above average, below 85 is considered below average.

  • Neurocognitive function DIGITChange from baseline at 3 and 6 months

    DIGIT test will be administered to evaluate short-term and working memory. This score is adjusted for age. Scored on a Standard scale of 100 +/- 15 for normal ranges, above 115 is above average, below 85 is considered below average.

  • Neurocognitive function WASIChange from baseline at 3 and 6 months

    Abbreviated Wechsler Abbreviated Scale of Intelligence (WASI) will be administered to evaluate verbal comprehension and working memory. This score is adjusted for age. Scored on a Standard scale of 100 +/- 15 for normal ranges, above 115 is above average, below 85 is considered below average.

  • Neurocognitive function WMSChange from baseline at 3 and 6 months

    Wechsler Memory test (WMS) will be administered to measure Verbal comprehension, and working and visual memory. Scored on a Standard scale of 100 +/- 15, where a higher score is a better outcome.

  • Neurocognitive function PVTChange from baseline at 3 and 6 months

    Psychomotor Vigilance Test (PVT) will be administered to measure Alertness and vigilance, in terms of number of lapses and reaction time. The performance score ranges from 0-100, where a higher value is a better outcome.

  • Neurocognitive function HVLT-RChange from baseline at 3 and 6 months

    Hopkins Verbal Learning Test - Revised (HVLT-R) will be administered to evaluate Verbal learning and memory. Scored on a Standard scale of 100 +/- 15, where a higher score is a better outcome.

  • Sleepiness ESSChange from baseline at 3 and 6 months

    Epworth sleepiness scale (ESS) score will be measured. This score is on a scale of 0-24, where a higher value indicates greater degree of sleepiness.

  • Sleep quality PSQIChange from baseline at 3 and 6 months

    Pittsburgh Sleep Quality Index (PSQI) is a detailed assessment of subject sleep quality over the most recent month by considering seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score to assess sleep quality on a scale of "poor" to "good".

  • Quality of life SF-36v2Change from baseline at 3 and 6 months

    QoL will be assessed using the survey SF-36v2 Health survey. Thirty-five of the SF-36v2 items are used to measure eight domains of health-related quality of life. These are on a scale of 0-100, where higher values indicate a better outcome.

  • Quality of life FOSQChange from baseline at 3 and 6 months

    Disease specific QoL will be assessed using the Functional Outcomes of Sleep Questionnaire FOSQ/(FOSQ). There are 5 subscale domains of the FOSQ (General Productivity, Social Outcome, Activity Level, Vigilance, and Intimate Relationships and Sexual Activity). There all range from 0-20, where a higher value is a better outcome. The total FOSQ is the sum of these subscale domains and ranges from 0-100, where a higher value is a better outcome.

  • Quality of life SGRQChange from baseline at 3 and 6 months

    Disease specific QoL will be assessed using the St. George's Respiratory Questionnaire (SGRQ). The SGRQ has three subscale domains (Symptoms, Activity, and Impacts), which range from 0-100, where a higher value indicates a worse outcome. The total SGRQ is the average of these subscale domains and is on a scale of 0-100, where a higher value is a worse outcome.