Concurrent Obstructive Sleep Apnea (OSA) and Chronic Obstructive Pulmonary Disease (COPD)

Obstructive sleep apnea (OSA) happens when you repeatedly stop breathing during sleep. These pauses are temporary, but they’ll partially wake you up. This can make it difficult to get a good night’s sleep.

Chronic obstructive pulmonary disease (COPD) refers to a group of lung conditions. That classically involves emphysema and chronic bronchitis. These conditions make it difficult to breathe when you’re awake and asleep.

Both OSA and COPD are common. But when sleep apnea and COPD happen at the same time, it’s known as overlap syndrome. It’s estimated that 10 to 15 percent of people with COPD also have sleep apnea.

This article will cover overlap syndrome, how it’s diagnosed, the treatment options, and outlook.

What can cause COPD and sleep apnea to happen together? 

According to a 2017 review, OSA and COPD often happen together due to chance. That’s because each condition is already common on its own.

However, OSA and COPD are linked in several ways:

• Inflammation. Both conditions involve inflammation. The inflammation caused by obstructive sleep apnea can worsen the inflammation in COPD, and vice versa.
• Cigarette smoking. Smoking cigarettes is associated with both OSA and COPD. It triggers inflammation, increasing the risk of both conditions.
• Obesity. Obesity is a strong predictor for having coexisting obstructive sleep apnea. It increases the probability of having OSA to more than 50 percent in men, and approximately 20 to 30 percent in women.

Does obstructive sleep apnea cause COPD, or vice versa?

Obstructive sleep apnea and COPD often coexist. But there isn’t a direct causal relationship.

OSA isn’t caused by COPD. Instead, it’s caused by factors like enlarged tonsils and neuromuscular disorders.

Meanwhile, COPD is usually caused by chronic exposure to irritants. This includes substances like cigarette smoke, secondhand smoke, air pollution, and chemical fumes.

Having OSA doesn’t mean you’ll develop COPD. Likewise, having COPD doesn’t mean you’ll develop obstructive sleep apnea.

However, since both conditions involve airway inflammation, they often appear together. This is more likely if you smoke cigarettes, which is a risk factor for both diseases.

Risks of having overlap syndrome

Overlap syndrome increases your chances of developing other health issues.

Short-term risks and side effects

If you have both COPD and obstructive sleep apnea, it can be difficult to breathe during sleep. This can interfere with your quality of sleep.

You may have short-term side effects like:

• frequently waking up at night
• daytime sleepiness
• excessive snoring
• sleep disorders

Long-term risks and side effects

COPD and obstructive sleep apnea reduce oxygen levels in your body. They also promote chronic inflammation.

Over time, this increases the risk of heart disease, including:

• abnormal heartbeat
• right-sided heart failure
• high blood pressure
• pulmonary hypertension (high blood pressure in the lungs)
• stroke

Diagnosing obstructive sleep apnea and COPD

A doctor can use several tests to diagnose OSA and COPD. The most appropriate tests depend on whether you’ve already been diagnosed with obstructive sleep apnea, COPD, or neither.

Tests include:

• Overnight oximetry. This is a test that measures your blood oxygen levels overnight. It can be used as a screening tool to determine if you experience low blood oxygen levels during sleep.
• Sleep apnea test. An in-lab sleep apnea test, also known as polysomnography (PSG), is the gold standard used to diagnose sleep apnea. It measures multiple factors like your breathing patterns, blood oxygen levels, and stages of sleep and body position. An alternative for select patients is a home sleep test (HST), where patients can sleep in their own bed.
• Arterial blood gas (ABG). The test is used to check the function of the patient’s lungs and how well they are able to move oxygen into the blood and remove carbon dioxide.

How is overlap syndrome treated?

Overlap syndrome is treated by managing each separate condition. The goal is to prevent low blood oxygen levels and the build-up of carbon dioxide during sleep, and to improve quality of sleep.

Non-invasive positive airway pressure therapy

Positive airway pressure (PAP) therapy is used to improve breathing during sleep:

• Continuous positive airway pressure. Continuous positive airway pressure (CPAP) provides a stream of constant pressure, which decreases resistance in the upper airways. This makes it easier to breathe during sleep.
• Bilevel positive airway pressure. Provides positive airway pressure that changes as you inhale and exhale. This supports the act of breathing, and helps with elevated carbon dioxide levels in the blood.

Oxygen therapy

Long-term oxygen therapy increases survival and improves the quality of life of hypoxemic patients with chronic obstructive pulmonary disease (COPD). It’s often prescribed for other patients with hypoxemic chronic lung disease.

But oxygen therapy is ineffective for obstructive sleep apnea. If you have overlap syndrome, you’ll need to address the obstructive apneas with either CPAP or bilevel positive airway pressures and assess whether you still need supplemental oxygen.

Bronchodilators

Bronchodilators are inhaled medications that open up your airways. They can help make breathing easier during the day and at night.

Inhaled bronchodilators help with many symptoms of COPD. Your doctor might prescribe multiple bronchodilators, depending on your severity of COPD.

Pulmonary rehabilitation

Pulmonary rehabilitation refers to a group of therapies and lifestyle changes that can improve overlap syndrome.

This includes:

• structured exercise programs
• quitting smoking (this can be difficult, but a doctor can help create a cessation plan that works for you)
• getting a good night’s sleep repeatedly
• staying a healthy weight

These changes won’t treat overlap syndrome on their own. However, they can help manage symptoms and improve quality of life.

When to see a doctor

If you’ve been diagnosed with overlap syndrome, visit your doctor regularly. Since sleep apnea and COPD are chronic, your doctor will need to monitor your progress.

See your doctor if you have:

• increased daytime sleepiness
• increased snoring
• poor quality of sleep
• difficulty staying asleep
• increased coughing, especially in the morning

Living with COPD and sleep apnea 

Living with obstructive sleep apnea or COPD can be difficult. These effects are even greater if you have both.

Generally, you can expect a better prognosis if both diseases are diagnosed and treated early. This can reduce the risk of either condition worsening the other.

After diagnosis, managing overlap syndrome requires long-term treatment. This includes routine disease management, which is essential for:

• reducing the risk of heart disease
• reducing hospital visits
• improving quality of life

What’s the life expectancy for someone with COPD and sleep apnea?

There’s currently no specific data on the life expectancy for people with both conditions. However, a 2017 scientific review notes that the mortality rate is higher in overlap syndrome than COPD or obstructive sleep apnea alone.

Takeaway

Overlap syndrome occurs when you have both obstructive sleep apnea and COPD. It’s common for these conditions to coexist, but they don’t necessarily cause each other. Having OSA and COPD can make breathing difficult.

Treatment options include non-invasive positive airway pressure therapy, oxygen therapy, bronchodilators, and pulmonary rehabilitation. The goal of treatment is to improve breathing and blood oxygen levels, and to reduce the build-up of carbon dioxide in the blood.

Overlap syndrome can increase your risk of heart disease. Regular disease management and long-term treatment is key for improving your outlook.

 

References

https://www.healthline.com/health/copd-and-sleep-apnea

The experts continually monitor the health and wellness space, and they update our articles when new information becomes available.

Current Version

Jul 19, 2021

Written By

Kirsten Nunez

Edited By

Roman Gokhman

Medically Reviewed By

Raj Dasgupta, M.D.

Copy Edited By

Megan McMorris