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Overlap syndrome is a term used to describe the coexistence of obstructive sleep apnea (OSA) and COPD, and was first coined by researcher David Flenley when he estimated that this association of two common diseases probably involved many patients.1 Indeed, research has indicated a high prevalence of OSA in COPD patients, including one recent study that shows up to 66% of the COPD patients who enrolled in pulmonary rehabilitation tested positive for OSA.2 Furthermore, patients with overlap syndrome may experience worsening symptoms of COPD.3
Continuous positive airway pressure (CPAP) remains the standard treatment for both OSA and overlap syndrome.13 Research has shown that patients with overlap syndrome who use CPAP therapy have experienced:
However, as an overlap syndrome patient’s disease progresses, they may develop daytime hypercapnia. CPAP alone may not fully correct hypercapnia or hypoxemia, so non-invasive ventilation (NIV) treatment and/or supplemental oxygen may increase the clinical benefit to the patient.18 NIV therapy can theoretically rest overloaded respiratory muscles, prevent nocturnal hypoventilation, and reset central respiratory drive in patients with hypercapnia.19 NIV devices also include several synchronization features that can prolong expiratory time, which helps to prevent air trapping and may greatly improve patient comfort and compliance.
As studies suggest that patients with overlap syndrome may have a worse prognosis than patients with only one of these diseases, COPD care providers should consider screening all of their COPD patients for obstructive sleep apnea.
There are several tools to help screen these patients during a regularly scheduled appointment. The American Sleep Apnea Association endorses three tests that you can quickly and easily administer and will help you identify your patients most at risk for sleep apnea:
American Thoracic Society/European Respiratory Society guidelines also suggest that those with relatively mild COPD and evidence of pulmonary hypertension should be referred for overnight testing.20
Soler X et al. High prevalence of obstructive sleep apnea in patients with moderate to severe chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2015;12(8):1219-25. dos: 10.1513/AnnalsATS.201407-336OC
Marin JM et al. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome Am J Respir Crit Care Med 2010 Aug 1;182(3):325-31. doi: 10.1164/rccm.200912-1869OC. Epub 2010 Apr 8.
Stanchina ML et al. Impact of CPAP use and age on mortality in patients with combined COPD and obstructive sleep apnea: the overlap syndrome. J Clin Sleep Med 2013 Aug 15;9(8):767-72. doi: 10.5664/jcsm.2916.
Toraldo DM et al. Fixed-pressure nCPAP in patients with obstructive sleep apnea (OSA) syndrome and chronic obstructive pulmonary disease (COPD): a 24-month follow-up study. Sleep Breath 2010 Jun;14(2):115-23. doi: 10.1007/s11325-009-0291-1. Epub 2009 Sep 13.
Mansfield D et al. Effects of continuous positive airway pressure on lung function in patients with chronic obstructive pulmonary disease and sleep disordered breathing. Respirology 1999 Dec;4(4):365-70.
Sampol G et al. Nasal continuous positive airway pressure with supplemental oxygen in coexistent sleep apnoea-hypopnoea syndrome and severe chronic obstructive pulmonary disease. Eur Respir J 1996 Jan; 9(1):111-6
Bhatt SP et al. Noninvasive positive pressure ventilation in subjects with stable COPD: a randomized trial. Int J Chron Obstruct Pulmon Dis 2013; 8: 581–589. Published online 2013 Nov 22. doi: 10.2147/COPD.S53619