Respiratory Disorders and Sleep Disturbances: Connection, Parallels, and Beyond
Overlap Syndrome (OS), the co-occurrence of Obstructive Sleep Apnea (OSA) and Chronic Obstructive Pulmonary Disease (COPD), can pose significant challenges for individuals affected by both conditions. Both COPD and OSA can cause breathing difficulties during sleep, and the prevalence of both conditions increases with age.
Effective management of Overlap Syndrome requires a combined approach, addressing both respiratory support and pharmacological management. Key treatments include:
- Continuous Positive Airway Pressure (CPAP) therapy combined with supplemental oxygen: CPAP helps keep the airway open during sleep, while supplemental oxygen corrects low blood oxygen levels common in COPD, improving oxygen saturation, reducing heart and lung strain, and potentially slowing disease progression.
- Pharmacological management: This generally includes inhaled bronchodilators and inhaled corticosteroids to control COPD symptoms. Additionally, newer biologic therapies originally approved for asthma, such as dupilumab and mepolizumab, show promise in patients with overlapping eosinophilic inflammation traits, reducing exacerbations and improving lung function.
- Lifestyle modifications and multidisciplinary care: Smoking cessation, exercise, and nutritional support are essential. Management by a team including pulmonologists, sleep specialists, and primary care providers ensures comprehensive assessment and adjustment of therapies.
Unfortunately, there is no cure for COPD. The prognosis for COPD, OSA, and OS will depend on how well a person manages lifestyle factors and follows their treatment.
Potential complications of Overlap Syndrome include an increased risk of cardiovascular disease and pulmonary hypertension, more severe hypoxemia and hypercapnia, higher rates of exacerbations and hospitalizations, and daytime somnolence and impaired quality of life.
A 2020 article found that two factors of COPD - hyperinflation of the lungs and the trapping of air in the lungs - can reduce the body's response to low oxygen levels during sleep, contributing to OSA and its severity. People with OS are more likely to experience nocturnal oxygen desaturation, hypercapnia, and hypoxia compared to those with COPD or OSA alone.
Noninvasive ventilation, with CPAP as one of the two main modes, is the definitive treatment for OS. The survival rate of people who do not receive noninvasive PAP is significantly lower than that of people who do.
It's important to note that both COPD and OSA affect the airways and how the body can access fresh air. Lack of oxygen in the blood results in oxidative stress, which causes the release of systemic inflammatory mediators. Inflammation in the lungs contributes to both COPD and OSA.
Quitting smoking is the most beneficial factor for people with COPD. Doctors may also recommend pulmonary rehabilitation to help manage symptoms and improve quality of life for people with COPD.
In summary, effective management of Overlap Syndrome requires combined respiratory support (CPAP plus oxygen), pharmacologic treatment typically aimed at COPD, emerging biologics for specific inflammation profiles, alongside lifestyle and multidisciplinary approaches, to reduce serious complications from compounded cardiopulmonary dysfunction.
- Individuals with Overlap Syndrome (OS) often experience sleep disruptions, such as nocturnal oxygen desaturation, hypercapnia, and hypoxia, which can negatively impact their health and wellness.
- The science behind COPD and Obstructive Sleep Apnea (OSA) in Overlap Syndrome suggests that hyperinflation of the lungs and the trapping of air can reduce the body's response to low oxygen levels during sleep, worsening OSA.
- The potential complications of OS include an increased risk of chronic diseases like cardiovascular diseases and pulmonary hypertension, exacerbations, hospitalizations, and impaired quality of life, highlighting the importance of proper medical-conditions management and health-and-wellness maintenance.
