Overlap Syndrome: Understanding Sleep Apnea and COPD

Obstructive sleep apnea (OSA) is a serious sleep disorder that occurs in approximately 10 to 15% of all patients with COPD.[1] When OSA and COPD coexist, they are commonly coined as “overlap syndrome.” Sleep apnea is generally caused by an obstruction of the upper airway during sleep (OSA), but it can also be caused by a failure of the brain to initiate a breath (central sleep apnea).  Left untreated, people with both conditions have an increased risk of death and hospitalizations due to COPD exacerbation.1

Symptoms of Sleep Apnea

People with sleep apnea repeatedly stop (or nearly stop) breathing during sleep. These episodes, which can last 10 seconds or more, cause oxygen levels in the blood to drop which may lead to additional serious health consequences.

Symptoms of sleep apnea include:1

  • Extremely loud snoring or an abnormal pattern of snoring with pauses and long gaps between breaths
  • Excessive daytime fatigue and sleepiness
  • Morning headaches
  • Changes in memory
  • Depression
  • Irritability
  • Erectile dysfunction

In general, people with untreated sleep apnea have more automobile accidents and a higher level of family and social discord compared to people who don’t have OSA. They also frequently suffer from a decreased quality of life.

Risk Factors for Sleep Apnea

Smoking and the use of alcohol, sedatives and/or tranquilizers are important risk factors for OSA. Others include:[2]

  • Being male
  • Obesity
  • Being older
  • Being African American
  • Having a short, large neck
  • Having a family history of OSA
  • Nasal congestion

Health Consequences of Overlap Syndrome

People with overlap syndrome have a higher degree of hypoxemia (low blood oxygen levels) and hypercapnia (high carbon dioxide levels) than people who have COPD, alone. Overlap syndrome also contributes to a higher prevalence of pulmonary hypertension, right-sided heart failure (cor pulmonale), and overall ill health. In addition, OSA has been linked to heart disease, general high blood pressure, irregular heart rhythms, heart attack, and stroke.[3]

Treatment for OSA

The simplest treatment for OSA in cases of obesity is weight loss. For many people, however, weight loss is not an attainable, long-term goal. Consequentially, continuous positive airway pressure therapy (CPAP) is the most common treatment for OSA. Other treatment options include dental devices such as tongue-retaining devices or bite guards, or corrective surgery if your OSA is severe and you’re unable to tolerate CPAP.

What is CPAP?

CPAP therapy is delivered by a machine that’s designed to increase the air pressure in your throat when you take a breath in, thus preventing your airway from collapsing while you sleep. It can be used with a mask that covers your nose and mouth, a mask that covers only your nose, or nasal prongs.[4]

Benefits of CPAP in Overlap Syndrome

CPAP used along with supplemental oxygen has the following benefits for people with overlap syndrome who experience a decrease in oxygen saturation when they sleep:[5]

  • Eliminates periods of apnea (pauses in breathing) and sub-optimal breathing during sleep
  • Corrects oxygen desaturation
  • Increases forced expiratory volume in one second (FEV1)and forced vital capacity (FVC)
  • Decreases carbon dioxide levels in the blood
  • Improves gas exchange in the lungs
  • Decreases hospitalizations

If you use or have a need for supplemental oxygen, call Inogen at 1-800-678-5572 to learn how the Inogen One or Inogen At Home oxygen concentrator can meet your supplemental oxygen needs.

For people who don’t experience a drop in oxygen while they sleep but are diagnosed with OSA, CPAP can be used without supplemental oxygen.

Do You Have Sleep Apnea?

Do you snore loudly? Does your bedroom partner complain about your snoring? If so, you may want to rule out sleep apnea as the root of your sleep problems. Other questions to ask yourself include:[6]

  • Does your snoring wake you up at night?
  • Do you or your bedroom partner notice that you make gasping or choking sounds during sleep?
  • Do you have a dry mouth, sore throat, or headache in the morning?
  • Do you fall asleep during the day, even when you don’t want to?
  • Are you frequently tired during the day?
  • Do you have high blood pressure?

If you snore excessively and have any of the problems listed above, you should be evaluated for sleep apnea. Because early diagnosis and treatment are important for avoiding serious complications associated with overlap syndrome, consider making an appointment with your health care provider as soon as possible to discuss a sleep evaluation.

[1] Xavier Soler, MD, PhD, Assistant Professor of Medicine, Pulmonary and Critical Care Division, University of California San Diego. Sleep Apnea and COPD: What Patients Should Know. COPD Foundation. July 25, 2011.

[2] Mayo Clinic. Sleep Apnea Risk Factors. July 24, 2012.

[3] Victor, Lyle D. M.D. Obstructive Sleep Apnea. American Family Physician. November 15, 1999.

[4] WebMD. Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnea. Updated January 14, 2014.

[5] Carlos Zamarrón Sanz, Carlos Rábade Castedo, Ester Zamarrón de Lucas, Emilio Morete Aracay and Félix del Campo Matias. Sleep and its Disorders Affect Society. September 24, 2014,

[6] Pronzato C. Chronic obstructive pulmonary disease and obstructive sleep apnea: Association, consequences and treatment. Monaldi Arch Chest Dis. 2010 Dec;73(4):155-61.

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