COPD-OSA Overlap Syndrome: evolving evidence regarding epidemiology, clinical consequences, and management

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA) are both highly prevalent, which implies that both disorders occurring together (overlap syndrome) is likely to be common based on chance association alone. However, different clinical COPD phenotypes influence the likelihood of co-existing OSA in that the increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA, whereas the higher likelihood of peripheral edema and increased BMI associated with the predominant chronic bronchitis phenotype promotes OSA. Both COPD and OSA are associated with similar physiological and molecular consequences such as hypoxia and systemic inflammation that contribute to cardiovascular and other co-morbidities, and pulmonary hypertension is highly prevalent in patients with the overlap syndrome. However, there have been few published reports that have evaluated systemic inflammation and other cardiovascular co-morbidities in overlap patients. The diagnosis of OSA in patients with COPD requires awareness of relevant clinical features and screening questionnaires may help identify suitable patients for further overnight study. The recognition of co-existing OSA in COPD patients has important clinical relevance as the management of patients with overlap syndrome is different from COPD alone, and the survival of overlap patients not treated with nocturnal positive airway pressure is significantly inferior to those overlap patients appropriately treated.

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