Understanding COPD and Sleep Apnea Overlap Syndrome

By Dr. Ernesto Eusebio

Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA) are two distinct but often overlapping respiratory conditions that impact millions of Americans. COPD is a progressive condition, characterized by difficulty in breathing due to long-term exposure to lung irritants, while OSA is a sleep disorder marked by repeated episodes of blocked airflow during sleep. When these conditions co-occur, they form what is known as “COPD and Sleep Apnea Overlap Syndrome.” This complex syndrome presents unique challenges in diagnosis, treatment, and management. Dr. Ernesto Eusebio, Board Certified in Sleep Medicine at the Sleep and Apnea Institute of FL, explores the critical aspects of this condition and highlights the importance of early intervention and specialized care.

The Mechanisms of COPD and OSA
COPD is primarily caused by chronic exposure to harmful irritants, most notably tobacco smoke, which leads to irreversible damage to the lungs. Individuals with COPD often experience symptoms such as shortness of breath, frequent coughing, and chest tightness, which can worsen over time. OSA, on the other hand, is commonly linked to physical obstruction in the upper airway, resulting in intermittent oxygen deprivation during sleep. The repetitive airway blockage often disrupts sleep and can lead to systemic complications, such as hypertension and cardiovascular disease.

In individuals with COPD, the presence of OSA can exacerbate breathing difficulties, particularly during sleep, when respiratory muscle tone naturally decreases. As detailed in a publication on the National Center for Biotechnology Information (NCBI), the interaction between COPD and OSA may intensify hypoxemia (low blood oxygen levels), leading to further declines in respiratory function and overall health Impact of Overlap Syndrome.

The combination of COPD and OSA presents distinct challenges. While each condition independently increases the risk of cardiovascular disease, diabetes, and decreased quality of life, together, they amplify these risks. Overlap Syndrome, as a combined condition, is associated with more severe nocturnal hypoxemia and an increased risk of mortality compared to those with COPD or OSA alone.

Studies show that individuals with Overlap Syndrome are more likely to experience:
• Higher levels of hypoxemia: The co-occurrence of COPD and OSA worsens oxygen deprivation, especially during sleep, which can significantly stress the cardiovascular system.
• Increased risk of acute exacerbations: Overlap Syndrome is associated with more frequent exacerbations of COPD symptoms, which may lead to increased hospitalizations.
• Higher likelihood of pulmonary hypertension:
Persistent low oxygen levels can lead to pulmonary hypertension, where the blood vessels in the lungs experience high blood pressure, leading to increased strain on the heart.

The NCBI review underscores the elevated mortality rate in Overlap Syndrome patients and the need for specialized interventions to mitigate these compounded health risks .

Sd Diagnosis
The symptoms of Overlap Syndrome may overlap with those of COPD and OSA, making it crucial to recognize the distinct clinical indicators. Common symptoms include:
• Chronic shortness of breath, especially during sleep
• Daytime fatigue and sleepiness, often due to sleep disruptions from OSA
• Loud snoring and episodes of gasping for air during sleep
• Morning headaches and dry mouth, often linked to sleep apnea

Diagnosing Overlap Syndrome requires a comprehensive evaluation that includes both pulmonary and sleep assessments. Polysomnography (sleep study) is typically used to confirm OSA, while spirometry is essential for evaluating COPD severity. Dr. Eusebio emphasizes the importance of coordinated diagnostic efforts, as a combined assessment can provide a more accurate picture of a patient’s respiratory health.

Sleep and Apnea Institute of Florida

(239)788-6500
www.saifsleep.com
23421 Walden Center Dr, Suite 100
Bonita Springs, FL 34134

References:
• NCBI. (2021). Overlap Syndrome in Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea. In StatPearls. Available at: https://www.ncbi.nlm.nih.gov/
books/NBK589658