The deleterious effects of chronic obstructive pulmonary disease and obstructive sleep apnea: pathophysiology and implications on treatment

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are both common in the adult population. The coexistence and association of both COPD and OSA have been described as the overlap syndrome. The scope of the present review is to address the magnitude, pathophysiology, clinical presentations, and the deleterious consequences of the coexistence of COPD and OSA in the same patient as well as the current management and treatment options of this association. Main body of abstract: Epidemiological studies showed a prevalence of the overlap syndrome of up to 1% of the adult population. However, various studies agreed that this association is due to the fact that both COPD and OSA are common rather than an interaction of pathophysiology between the two affections. Nevertheless, sleep may cause adverse effects on breathing and lung functions. While these effects can be neglected in otherwise healthy individuals, they can lead in contrast to disastrous clinical outcomes particularly in vulnerable patients with the overlap syndrome leading to increased risk of cardiovascular diseases, acute COPD exacerbations, increased rates of hospitalizations, and nocturnal deaths. Current guidelines recommend polysomnography (PSG) as the gold standard investigation to diagnose sleep disorders and overlap syndrome. Treatment may include pulmonary rehabilitation, supplemental oxygen therapy, and non-invasive ventilation. Currently, continuous positive airway pressure (CPAP) therapy is the treatment of choice for the overlap syndrome. CPAP effects include improved respiratory mechanics; sleep quality, exercise tolerance, and prolonged survival. Conclusion: Both COPD and OSA are common in the general population and present a significant risk of increased morbidity and mortality when they coexist in the same patient. Clinicians must carefully evaluate the clinical outcomes and the high risk of cardiovascular complications related to the overlap syndrome. Current data indicate that CPAP treatment leads to amelioration of the health-related quality of life and improve survival in patients with the overlap syndrome.

Exploration of Patients' Perceptions About Obstructive Sleep Apnea (OSA) and Their Efforts to Reduce the Risk: A Qualitative Study

“…Moreover, OSA is common in the general population and presents a significant risk of increased morbidity and mortality when they coexist in the same patient. Thus, clinicians should carefully evaluate the clinical outcomes and the high risk of OSA complications (Bonsignore et al, 2019;Gharib, 2020). This research is in line with research (Sia et al, 2017) that the general population's awareness and knowledge of OSA were low.…”

“…Obstructive sleep apnea is a dangerous sleep disorder, however, this problem is often underdiagnosed. If OSA is untreated, patients will experience health problems such as myocardial infarction, arrhythmias, pulmonary hypertension (Rachmawati et al, 2018), stroke, heart disease, brain damage, depression, diabetes, and mortality (Bonsignore et al, 2019;Gharib, 2020). Therefore, health education campaigns are needed to increase awareness about the risk of OSA so that they will change their lifestyle.…”

Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

“…COPD and OSA are frequent in the general population and give out a huge danger of expanded morbidity and mortality when they exist together in a similar patient. Clinicians should cautiously assess the clinical results and the high danger of cardiovascular problems connected to the overlap [17]. In the current work, studied groups were matched regarding age and sex distribution (most of the participants were males) while BMI and NC were higher in obese COPD patients.…”