Severity of nocturnal hypoxia and daytime hypercapnia predict CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

• Daytime hypercapnia and nocturnal hypoxia are independent predictors of early continuous positive airway pressure (CPAP) failure in patients with the obstructive sleep apnea-continuous positive airway pressure overlap syndrome• An increase of CT90% by 1% (ie, prolongation of time with SpO2 <90% by 1% of total sleep time) increases the likelihood of CPAP failure by ~6%• Bilevel positive airway pressure (BiPAP) therapy effectively alleviates hypercapnia in patients with primary CPAP failure• To increase sleep laboratory personnel alertness towards the risk of CPAP failure, it is desirable to carefully evaluate the CT90% with blood gas analysis during the daytime

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