COPD + OSA = OS

Obstructive sleep apnea (OSA) occurs when the breathing stops and starts repeatedly throughout the night. Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that make breathing difficult by blocking airflow in the lungs. When the two conditions occur together – which they do about 13% of the time – it results in a condition called overlap syndrome (OS).

OS can be a cause for concern, as the combination of symptoms from COPD and OSA may make it hard for the body to get enough oxygen. Too, compared to people with COPD or OSA alone, someone with OS is more likely to experience:

• Nocturnal oxygen desaturation (NOD) – when blood oxygen levels decrease during sleep
• Hypercapnia – too much carbon dioxide in the blood
• Hypoxia – not enough oxygen in the blood

Lack of oxygen in the blood leads to oxidative stress. This then causes the release of “messengers” that cause an inflammatory response in cells and blood vessels called systemic inflammatory mediators, which can lead to the hardening of the arteries and a type of coronary artery disease called endothelial dysfunction. As a result, people with OS have a higher risk of developing high blood pressure and heart failure.

In terms of treating OS, the most effective option is noninvasive positive airway pressure (PAP) using a continuous PAP (CPAP) machine during sleep. A mask is worn over the mouth and nose to introduce pressured air into the lungs as a person sleeps by splinting open the collapsed upper airways. Lifestyle changes such as quitting smoking, maintaining a moderate body weight and pulmonary rehabilitation and a structured exercise program can also be beneficial for those with OS.

Other potential options, which may not be suitable for everyone with OS, include supplemental oxygen at night and use of bronchodilators and corticosteroids.

Additional comment from Dr. Nair: It is well known that there is an association between COPD and sleep apnea, although this can sometimes be missed because people with COPD do not have the body type commonly associated with sleep apnea (classically thought of as overweight). If you have any symptoms of sleep apnea, mention it to your doctor. In addition to quality-of-life issues, sleep apnea can magnify some of COPD’s bad effects, such as low oxygen and pulmonary hypertension. 

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