COPD and Sleep Apnea Overlap: A Coincidence?

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are major global health problems that both affect the airways. COPD is characterised by persistent airway symptoms and restricted airflow, while OSA is characterised by repeated upper airway obstructions during sleep. Both conditions can have a significant impact on quality of life and require careful diagnosis and treatment.

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, you can check out the article Asthma-COPD Overlap: Challenges to Overcome . 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.

Positive airway pressure (PAP) therapy is widely regarded as the most appropriate and well-established therapeutic option for patients with COPD-OSA overlap syndrome. PAP therapy, which includes Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP), helps keep the airways open by providing a continuous stream of air through a mask. This prevents the collapse of the upper airway during sleep, thus alleviating symptoms of obstructive sleep apnea (OSA) and improving oxygenation.

Numerous studies have demonstrated that PAP therapy not only enhances the quality of sleep and reduces daytime sleepiness but also significantly improves the overall quality of life in patients with COPD-OSA overlap. Furthermore, it has been shown to improve lung function, reduce the frequency of COPD exacerbations, and lower healthcare utilization.

Crucially, patients with hypoxemia, COPD, and OSA who are treated with PAP therapy exhibit a markedly increased survival rate. This is attributed to the combined benefits of reduced nocturnal hypoxemia, improved sleep architecture, and decreased cardiovascular strain. Consistent use of PAP therapy has also been associated with a reduction in morbidity and mortality rates in this patient population. Hence, PAP therapy is a cornerstone in the management of COPD-OSA overlap, offering substantial benefits in terms of symptom relief, functional improvement, and longevity.

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 .