COPD and Sleep Apnea: Link, Similarities, and More

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

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 focus on improving a person’s ability to breathe as well as addressing 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.

COPD and OSA both affect the respiratory system and how the body accesses fresh air.

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

Additionally, the authors of a 2020 article found that two factors of COPD — hyperinflation of the lungs and air being trapped in the lungs — can decrease the body’s response to low oxygen levels during sleep. This low response is a major contributor to OSA and its severity.

According to a 2015 article, OSA is common in patients with moderate to severe COPD.

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

This is primarily due to restricted mobility of the chest wall and diaphragm that is characteristic of obstructive pulmonary diseases such as COPD. This results from air pockets in the lungs, making it difficult to breathe comfortably.

People with OSA stop breathing intermittently during sleep. This is due to the collapse of the upper airways, making airflow 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 because the combination of the symptoms of COPD and OSA can make it harder for the body to get enough oxygen.

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

  • nocturnal oxygen desaturation (NOD), in which the level of oxygen in the blood decreases during sleep
  • Hypercapnia, where there is too much carbon dioxide in the blood
  • Hypoxia, where there is not enough oxygen in the blood

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

This can lead to hardening of the arteries and a form 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, making them less efficient.

Chronic bronchitis causes inflammation of the airways called bronchi. The inflammation can also cause irritation, which can lead to mucus build-up. Combined, these factors can narrow the airways and make it harder for air to get through during waking hours.

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

The brain can sense the inability to breathe, causing a person to wake up very briefly to reactivate 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: B. large tonsils, and certain diseases, including obesity and hypothyroidism.

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

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

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

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

  • fatigue
  • frequent awakenings during sleep
  • Trouble breathing while sleeping

There is also a link between smoking and COPD and OSA. About 85-90% of all COPD cases are due to smoking.

According to a 2014 article, although smoking does not appear to be an independent risk factor for OSA, some studies show that people who currently smoke are more likely to develop the condition than people who have never smoked or have smoked.

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

Below are treatment options for people with OS.

Positive airway pressure

OS can cause severe oxygen deprivation during sleep.

Therefore, it is crucial for a person with OS to be treated with non-invasive positive airway pressure (PAP) while they sleep to help keep oxygen in their body while they sleep.

Doctors may recommend using a continuous pap (CPAP) machine while you sleep. This involves wearing a mask over the mouth and nose that introduces pressurized air into the lungs while you sleep by opening the collapsed upper airway.

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

Lifestyle Changes

This may include achieving or maintaining a moderate body weight or, if a person smokes, stopping smoking.

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

Exercise can:

  • reduces sleepiness during waking hours
  • improvement in sleep quality
  • Improving the quality of life of a person with COPD
  • Reduce hospital frequency
  • improve shortness of breath

Other possible treatment options

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

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 only beneficial for OSA.

Supplemental oxygen at night may help reduce the incidence of NOD, but it does not appear to improve overall sleep quality or limit sleep disruption 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 those with OSA.

Noninvasive ventilation

CPAP is one of the two main modes of Noninvasive Ventilation (NIV), Bilevel PAP is the other.

As the name suggests, CPAP delivers continuous pressure throughout the breathing cycle. This type of NIV breathing support uses a 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 depends on how well a person manages lifestyle factors and follows their treatment.

COPD is not curable. People who get treatment early and take steps to control risk factors can slow the progression of the disease and significantly improve their quality of life.

The Centers for Disease Control and Prevention (CDC) states that for people with COPD who smoke, smoking cessation is 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’s also the most effective treatment option for people with OS.

The research finds that the survival rate of people who don’t receive non-invasive PAP is significantly lower than that of people who receive the treatment.

Doctors may also recommend lifestyle changes that could improve treatment outcomes, such as: For example, quitting smoking, achieving or maintaining a moderate weight, and exercising regularly.

COPD and OSA are two different conditions that affect a person’s ability to breathe. They can also occur together and lead to 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, the most common form of NIV. This reduces resistance in the upper airways and improves airflow in and out of the lungs.

A person may also engage in regular physical activity and PR to help manage symptoms.

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