COPD and Sleep Apnea Overlap: A Coincidence?

Chronic obstructive pulmonary disease (COPD) is a serious global health issue that is characterized by respiratory symptoms and airflow limitation that occur persistently. Another common disorder is the so-called obstructive sleep apnea (OSA), which is characterized by repeated upper airway closures during sleep. Hear the resemblance? Affecting 9–38% of adults, OSA is associated with various comorbidities such as cardiovascular disease, hypertension, cognitive impairment, and diabetes. These two above mentioned obstructive diseases tend to coexist, causing the so-called “overlap syndrome” to be introduced. In the general population, the prevalence of the overlap syndrome is shown to have a range from 1-3.6%, while higher rates are observed in COPD and OSA patients.
Today, we would like to give you more insight on the overlap of COPD and OSA, as this is a common issue COPD patients are and may be facing. Unfortunately, it is no secret that the patients with the overlap syndrome have a worse prognosis than patients with COPD or OSA alone. Facing an increased risk of hospitalization due to COPD exacerbations, elevated risks of cardiovascular and metabolic comorbidities, the patients with the overlap of COPD and sleep apnea require more attention.
Firstly, it is to mention that the COPD-OSA overlap syndrome could seem similar to other respiratory overlap syndromes when it comes to diagnosis, like the asthma & COPD overlap. If you are interested in this topic, check out our article to find out more. Back to where we left off: In order to differentiate these respiratory conditions, pulmonary function testing and finding a consistent symptomatology of asthma are helpful.
After diagnosis, using Patient-Reported Outcome Measures (PROMs), a survey in assessing symptom severity, evaluating disease burden and quality of life in patients is a way to understand these patients’ symptoms and needs. However, currently, none of the identified PROMs for the overlap syndrome are fully validated. The lack of established content validity for most PROMs measuring health status is creating a problem for a patient-centered approach, which, in this case, is key to provide better management of both diseases, as some patients are facing an OSA- and some are facing a COPD- predominant overlap condition. It is of crucial importance to have the right tools, PROMs, to assess and address their problems. It is suggested that three OSA-related quality-of-life PROMs—the Pittsburgh Sleep Quality Index (PSQI), the Quebec Sleep Questionnaire (QSQ), and the Sleep Apnea Quality of Life Index (SAQLI)—have good content validity. However, there is still a lack of sufficient evidence to fully judge the quality of these PROMs.
We talked a lot about the diagnosis and symptom assessment, now what about the therapy? Positive airway pressure is said to be the most appropriate and well-established therapeutic option for COPD-OSA overlap. It has been shown by many studies that patients with hypoxemia, COPD, and OSA treated with positive airway pressure therapy have an increased survival rate.
In the same manner, it is known that COPD patients with this overlap syndrome who are receiving positive airway pressure therapy tend to have a decrease in hospitalizations and emergency room visits due to any cause. Not only these but also a lower rate of severe acute COPD exacerbations is also associated with positive airway pressure therapy, which means a lessening of the burden on the healthcare systems.
Overall, an approach that combines accurate diagnosis, validated PROMs, and effective therapeutic interventions, such as positive airway pressure, is crucial for enhancing the quality of life for individuals facing the complex challenges of the COPD-OSA overlap syndrome.
At Breathment, our mission involves enhancing the well-being of individuals with COPD by offering an easily accessible form of therapy. Our approach includes providing patients with targeted exercises aimed at managing COPD symptoms effectively. These exercises are tailored for you only - keeping your condition and symptoms in mind. If you think you have any other problems, such as sleep apnea, you can always contact your personal Breathment Coach to get further assistance on your condition.
Schedule your first online therapy session to discover more about our respiratory care approach and experience the Breathment Therapy App.