Obstructive sleep apnea (OSA) occurs when the breathing stops and starts repeatedly throughout the night. Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that make breathing difficult by blocking airflow in the lungs. The two conditions are different, but they may occur together and worsen each other’s symptoms.

When this happens, a condition called overlap syndrome (OS) occurs. This term was coined by David C. Flenley in 1985 to describe the existence of OSA in people with COPD.

Treatments for COPD and OSA will focus on improving a person’s ability to breathe as well as managing any lifestyle factors that increase the risk of the conditions.

In this article, we discuss the link between COPD and OSA. We also describe their differences and similarities and the available treatment options.

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COPD and OSA both affect the airways and how the body can access fresh air.

Researchers note that inflammation in the lungs contributes to both COPD and OSA. Both conditions can also cause breathing difficulties during sleep, which may be the reason a person sees a doctor.

In addition, authors of 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. This low response is an important contributor to OSA and its severity.

According to a 2015 article, OSA is common among those with moderate to severe COPD.

During sleep, people with COPD may experience lower levels of oxygen and high levels of carbon dioxide in the blood depending on the severity of their condition.

This mainly occurs due to reduced mobility of the chest wall and diaphragm, which is characteristic of obstructive lung disease, such as COPD. This results from air trapping in the lung and makes it difficult to breathe comfortably.

People with OSA stop breathing for periods of time during sleep. This is due to the collapse of the upper airways, which makes the delivery of air into the lungs less efficient.

OS develops when a person has both COPD and OSA. According to research, OS occurs in about 13% of cases.

OS can be a cause for concern, as the combination of symptoms from COPD and OSA may make it hard for the body to get enough oxygen.

A 2018 article reports that, compared with people with COPD or OSA alone, a person with OS is more likely to experience:

  • nocturnal oxygen desaturation (NOD), which is when the blood oxygen levels decrease during sleep
  • hypercapnia, which is when there is too much carbon dioxide in the blood
  • hypoxia, which is when there is not enough oxygen in the blood

Lack of oxygen in the blood results in oxidative stress. This then causes the release of messengers that act on cells and blood vessels to cause an inflammatory response, called systemic inflammatory mediators.

This can lead to the hardening of the arteries and a type of coronary artery disease called endothelial dysfunction.

As a result, people with OS have a higher risk of developing high blood pressure and heart failure.

Although both COPD and OSA affect breathing and oxygen levels, they are two different conditions.

The term COPD typically includes emphysema and chronic bronchitis. Emphysema damages the air sacs in the lungs and makes them less efficient.

Chronic bronchitis causes inflammation of the airways called bronchial tubes. The inflammation can also lead to irritation, which can result in a buildup of mucus. In combination, these factors can narrow the airways and make it harder for air to get through during wake times.

By contrast, OSA occurs during sleep. When the muscles in the back of the throat relax, the airway narrows or completely closes, making it difficult for a person to breathe in again.

The brain may sense the inability to breathe, and cause a person to wake up very briefly to re-engage the muscles and breathe again.

The causes of each condition also vary. COPD develops as a result of exposure to irritants over time.

OSA, on the other hand, occurs due to the physical structure of a person’s body, such as large tonsils, and certain medical conditions, including obesity and hypothyroidism.

Both conditions may make it difficult for the body to get enough oxygen.

OSA causes a person to stop breathing when they are asleep, and COPD can cause difficulty breathing during sleep, resulting in trouble falling asleep or staying asleep.

Also, COPD and OSA share some similarities when it comes to their symptoms and risk factors.

Both conditions affect a person’s quality of sleep and can cause:

  • fatigue
  • frequent waking up during sleep
  • problems with breathing when sleeping

Moreover, there is a link between smoking and COPD and OSA. Approximately 85–90% of all COPD cases occur due to smoking.

According to a 2014 article, although smoking does not appear to be an independent risk factor for OSA, some studies show the condition is more common among people who currently smoke than it is in people who have never smoked or used to smoke.

In addition, a 2015 article observes that the prevalence of both COPD and OSA increases with age and that the symptom onset is slow.

The following are treatment options for people with OS.

Positive airway pressure

OS can lead to a severe lack of oxygen during sleep.

It is therefore crucial for a person with OS to get treatment using noninvasive positive airway pressure (PAP) when sleeping, to help keep oxygen in their body while they are asleep.

Doctors may recommend using a continuous PAP (CPAP) machine during sleep. This involves wearing a mask over the mouth and nose that introduces pressured air into the lungs as a person sleeps, by splinting open the collapsed upper airways.

CPAP is the most effective treatment option for OS and OSA. It can improve the outlook for those with COPD and OSA. It can also reduce COPD exacerbation in people with OS.

Lifestyle changes

This may include reaching or maintaining a moderate body weight or, if a person smokes, quitting smoking.

Doctors may also recommend pulmonary rehabilitation (PR) and exercise. PR and a structured exercise program can be beneficial for those with OSA and COPD.

Exercise can:

  • reduce sleepiness during wake hours
  • improve sleep quality
  • better a person’s quality of life with COPD
  • reduce hospitalization frequency
  • improve shortness of breath

Other potential treatment options

Healthcare professionals may recommend the following types of treatment. However, they may not be suitable for all cases of OS, according to a 2018 article.

Supplemental oxygen

This is an effective treatment option for people with COPD who meet the criteria to receive oxygen to improve their survival rate. However, it is not beneficial for OSA alone.

Supplemental oxygen at night can help reduce the frequency of NOD, but it does not appear to improve the overall quality of sleep or limit sleep disturbances in most cases.

Supplemental oxygen is not a definitive treatment for OS.

Bronchodilators and corticosteroids

In people with COPD, bronchodilators relax and open the airways, while corticosteroids reduce airway inflammation.

However, this treatment does not benefit individuals with OSA.

Noninvasive ventilation

CPAP is one of the two main modes of noninvasive ventilation (NIV), with bilevel PAP being the other.

As the name suggests, CPAP provides continuous pressure throughout the respiratory cycle. This type of NIV breathing support uses a face or nasal mask and is an effective treatment option for people with OSA and even COPD.

NIV is the definitive treatment for OS.

The prognosis for COPD, OSA, and OS will depend on how well a person manages lifestyle factors and follows their treatment.

There is no cure for COPD. People who get treatment early on and take steps to manage the risk factors may slow the progression of the condition and greatly improve their quality of life.

The Centers for Disease Control and Prevention (CDC) note that for people with COPD who smoke, quitting smoking will be the most beneficial factor. Doctors may also recommend PR to help manage symptoms and improve quality of life.

The most important factor for people with OSA is restoring airflow during sleep. The National Heart, Lung, and Blood Institute states that a CPAP machine is the most common treatment for people with the condition.

It is also the most effective treatment option for those with OS.

Research notes that the survival rate of people who do not get noninvasive PAP is significantly lower than that of people who receive the treatment.

Doctors may also recommend lifestyle changes that could improve outcomes with treatment, such as quitting smoking, reaching or maintaining a moderate body weight, and exercising regularly.

COPD and OSA are two different conditions that affect a person’s ability to breathe. They can also occur together, resulting in a condition called OS, which increases a person’s risk of heart failure and high blood pressure.

The most effective treatment option for OS is CPAP, which is the most common form of NIV. This reduces the resistance in the upper airways, improving airflow in and out of the lungs.

A person can also take part in regular physical activity and PR to help manage symptoms.