Overlap Syndrome: Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease

Département de Pneumologie, Hôpitaux Universitaries de Strasbourg, France.
Proceedings of the American Thoracic Society 02/2008; 5(2):237-41. DOI: 10.1513/pats.200706-077MG
Source: PubMed


Chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome (SAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age, and their coexistence, which is denominated overlap syndrome, can be expected to occur in about 0.5% of this population. A recent epidemiologic study has shown that the prevalence of SAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiologic linkage between these two diseases. Patients with overlap have a more important sleep-related O(2) desaturation than do patients with COPD with the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory insufficiency and pulmonary hypertension when compared with patients with SAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Therapy of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal noninvasive ventilation (NIV), with or without associated nocturnal O(2). Patients who are markedly hypoxemic during daytime (Pa(O(2)) < 55-60 mm Hg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation.

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Available from: Romain Kessler, Jan 26, 2016
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    • "Both chronic obstructive pulmonary disease and obstructive sleep apnea are common [1]. It is estimated that 5–15% of adult population suffers from COPD [2]. "
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    ABSTRACT: Present study was designed to obtain association between sleep apnea with sleep quality and quality of life in COPD patients. This cross-sectional descriptive study was conducted on 139 patients with COPD in a chest clinic of a university hospital. All patients were evaluated by pulmonary function test for determination of severity of their disease. Also, Berlin questionnaire, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ) were employed for assessment of patients. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for sleep apnea. The patients were divided into two groups according to the result of Berlin questionnaire. Significant differences were found between the groups for total score and each of three subscores of SGRQ suggesting worse quality of life in overlap syndrome (P < 0.001). Also, patients with overlap syndrome had worse quality of sleep compared to patients without it (8.1 ± 1.7 versus 6.2 ± 2.3; P < 0.001). Stepwise multiple regression analysis showed that severity of COPD, coexisting obstructive sleep apnea, and sleep quality accounted for the SGRQ significantly (r (2) (coefficient of determination) = 0.08, 0.21, and 0.18, resp.). It is recommended that patient with COPD be evaluated for sleep apnea and sleep disorders during routine examinations and followups.
    Full-text · Article · Jan 2014
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    • "In OSA, AHI was a weak predictor of pulmonary arterial hypertension, whereas nocturnal oxygen desaturation was a more significant determinant of the presence of pulmonary hypertension. Subjects with the overlap syndrome can develop pulmonary hypertension with only mild to moderate obstruction [3]. This may result from the combined effects of both diseases contributing to hypoxemia and effects on pulmonary hemodynamics, with less of a contribution from the underlying mechanism from COPD or OSA [42]. "
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    ABSTRACT: The overlap syndrome of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD), in addition to obesity hypoventilation syndrome, represents growing health concerns, owing to the worldwide COPD and obesity epidemics and related co-morbidities. These disorders constitute the end points of a spectrum with distinct yet interrelated mechanisms that lead to a considerable health burden. The coexistence OSA and COPD seems to occur by chance, but the combination can contribute to worsened symptoms and oxygen desaturation at night, leading to disrupted sleep architecture and decreased sleep quality. Alveolar hypoventilation, ventilation-perfusion mismatch and intermittent hypercapnic events resulting from apneas and hypopneas contribute to the final clinical picture, which is quite different from the “usual” COPD. Obesity hypoventilation has emerged as a relatively common cause of chronic hypercapnic respiratory failure. Its pathophysiology results from complex interactions, among which are respiratory mechanics, ventilatory control, sleep-disordered breathing and neurohormonal disturbances, such as leptin resistance, each of which contributes to varying degrees in individual patients to the development of obesity hypoventilation. This respiratory embarrassment takes place when compensatory mechanisms like increased drive cannot be maintained or become overwhelmed. Although a unifying concept for the pathogenesis of both disorders is lacking, it seems that these patients are in a vicious cycle. This review outlines the major pathophysiological mechanisms believed to contribute to the development of these specific clinical entities. Knowledge of shared mechanisms in the overlap syndrome and obesity hypoventilation may help to identify these patients and guide therapy.
    Full-text · Article · Nov 2013 · Respiratory research
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    • "In patients with overlap syndromes, hypoxemia and hypercapnic induced pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction. This is different from " usual " COPD because the two syndromes may induce much greater changes in hemodynamic and respiratory as well as neurological functions [7]. The gold standard therapy for OSAS and overlap syndrome remains CPAP or Bi- PAP therapy [8]. "
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    ABSTRACT: We present four cases of adults with obstructive sleep apnea in whom positive airway pressure therapy alone failed to provide adequate oxygenation. We have previously reported the use of dual mask for ventilatory support of a patient postoperatively (Porhomayon et al., 2013). Here, we report an evaluation of the dual mask in four patients with overlap syndromes. Application of dual mask provided adequate oxygenation with lower continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BIPAP) pressure levels.
    Full-text · Article · Jul 2013 · Case Reports in Medicine
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