Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome: Narrative Review
Main Article Content
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are among the most common respiratory disorders, and their coexistence, termed COPD-OSA Overlap Syndrome (OVS), poses unique diagnostic and therapeutic challenges. OVS affects approximately 1% of adults, yet it’s true prevalence is likely underestimated due to variable diagnostic criteria and under recognition. The combination of chronic airflow limitation, recurrent nocturnal hypoxia, and sleep fragmentation creates a synergistic pathophysiological burden characterized by heightened systemic inflammation, oxidative stress, endothelial dysfunction, and autonomic imbalance. These mechanisms contribute to an increased risk of pulmonary hypertension, right-sided heart failure, arrhythmias, and overall cardiovascular morbidity and mortality compared with either disease alone. Clinically, OVS patients experience more profound nocturnal desaturation, greater daytime hypercapnia, and a higher frequency of exacerbations and hospitalizations. Diagnosis relies on screening tools such as the STOP-Bang or NoSAS questionnaires, with confirmation by polysomnography, though oximetry and capnometry remain valuable alternatives in resource-limited settings. Optimal management integrates aggressive treatment of COPD, lifestyle modification, and positive airway pressure therapy, particularly continuous positive airway pressure, which improves oxygenation, reduces exacerbations, and restores survival rates comparable to those of COPD-only patients. Despite its clinical importance, OVS remains understudied, underscoring the need for standardized diagnostic criteria, multicenter prospective trials, and a phenotype-based approach to guide individualized management and improve outcomes in this high-risk population.
Article Details
How to Cite
KAUR, Antarpreet; DAGHER, Chebly.
Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Overlap Syndrome: Narrative Review.
Medical Research Archives, [S.l.], v. 14, n. 1, jan. 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7176>. Date accessed: 03 feb. 2026.
doi: https://doi.org/10.18103/mra.v14i1.7176.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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6. Chaouat A, Weitzenblum E, Krieger J, Ifoundza T, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. American journal of respiratory and critical care medicine. 1995;151(1):82-86.
7. Owens RL, Malhotra A. Sleep-disordered breathing and COPD: the overlap syndrome. Respiratory care. 2010;55(10):1333-1346.
8. Butt M, Dwivedi G, Khair O, Lip GY. Obstructive sleep apnea and cardiovascular disease. International journal of cardiology. 2010;139(1):7-16.
9. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Elsevier; 2004:1036-1046.
10. Sin DD, Man SP. Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease. Canadian journal of physiology and pharmacology. 2005;83(1):8-13.
11. Mermigkis C, Kopanakis A, Foldvary‐Schaefer N, et al. Health‐related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome). International journal of clinical practice. 2007;61(2):207-211.
12. Lavie P, Herer P, Lavie L. Mortality risk factors in sleep apnoea: a matched case–control study. Journal of sleep research. 2007;16(1):128-134.
13. Shaya FT, Lin P-J, Aljawadi MH, Scharf SM. Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome. Sleep and Breathing. 2009;13:317-323.
14. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. New England journal of medicine. 1993;328(17):1230-1235.
15. Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006;130(1):149-156.
16. Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. American journal of respiratory and critical care medicine. 2004;169(2):168-173.
17. Bednarek M, Plywaczewski R, Jonczak L, Zielinski J. There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study. Respiration. 2005;72(2):142-149.
18. Resta O, Barbaro MPF, Brindicci C, Nocerino MC, Caratozzolo G, Carbonara M. Hypercapnia in overlap syndrome: possible determinant factors. Sleep and Breathing. 2002;6:11-17.
19. Greenberg-Dotan S, Reuveni H, Tal A, et al. Increased prevalence of obstructive lung disease in patients with obstructive sleep apnea. Sleep and Breathing. 2014;18:69-75.
20. Larsson L, Lindberg A, Franklin K, Lundbäck B. Obstructive Lung Disease in Northern Sweden Studies. Obstructive sleep apnoea syndrome is common in subjects with chronic bronchitis: report from the Obstructive Lung Disease in Northern Sweden studies. Respiration. 2001;68(3):250-255.
21. Sanders MH, Newman AB, Haggerty CL, et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. American journal of respiratory and critical care medicine. 2003;167(1):7-14.
22. Turcani P, Skrickova J, Pavlik T, Janousova E, Orban M. The prevalence of obstructive sleep apnea in patients hospitalized for COPD exacerbation. Biomedical Papers. 2015;159(3):422-428.
23. Sharma B, Feinsilver S, Owens RL, Malhotra A, McSharry D, Karbowitz S. Obstructive airway disease and obstructive sleep apnea: effect of pulmonary function. Lung. 2011;189:37-41.
24. Janson C, Marks G, Buist S, et al. The impact of COPD on health status: findings from the BOLD study. European Respiratory Journal. 2013;42(6):1472-1483.
25. Sharma S, Hashmi M, Chakraborty R. StatPearls [Internet] StatPearls Publishing. Treasure Island (FL): Sep. 2021;18
26. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. American journal of respiratory and critical care medicine. 2010;182(5):598-604.
27. Boers E, Barrett M, Su JG, et al. Global burden of chronic obstructive pulmonary disease through 2050. JAMA Network Open. 2023;6(12):e2346598-e2346598.
28. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proceedings of the American thoracic society. 2008;5(2):144-153.
29. Choudhary SS, Choudhary SR. Sleep effects on breathing and respiratory diseases. Lung India. 2009;26(4):117-122.
30. Edwards BA, White DP. Control of the pharyngeal musculature during wakefulness and sleep: implications in normal controls and sleep apnea. Head & neck. 2011;33(S1):S37-S45.
31. Strohl KP, Butler JP, Malhotra A. Mechanical properties of the upper airway. Comprehensive Physiology. 2012;2(3):1853.
32. Locke BW, Lee JJ, Sundar KM. OSA and chronic respiratory disease: mechanisms and epidemiology. International Journal of Environmental Research and Public Health. 2022;19(9):5473.
33. Edwards BA, Eckert DJ, Jordan AS. Obstructive sleep apnoea pathogenesis from mild to severe: Is it all the same? Respirology. 2017;22(1):33-42.
34. Dewald D, Strohl KP. Mechanical Properties, Anatomy, and Control of the Upper Airway. Upper Airway Stimulation Therapy for Obstructive Sleep Apnea: Medical, Surgical, and Technical Aspects. 2021:27.
35. Yoshikawa F, Nozaki-Taguchi N, Yamamoto A, et al. Preoperative sleep-disordered breathing and craniofacial abnormalities are risk factors for postoperative sleep-disordered breathing in patients undergoing skin-flap oropharyngeal reconstruction surgery for oral cavity cancer: a prospective case-control study. Sleep and Breathing. 2024;28(2):797-806.
36. Lewis CA, Fergusson W, Eaton T, Zeng I, Kolbe J. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax. 2009;64(2):133-138.
37. Ramsey R, Mehra R, Strohl KP. Variations in physician interpretation of overnight pulse oximetry monitoring. Chest. 2007;132(3):852-859.
38. McNicholas WT. COPD-OSA overlap syndrome: evolving evidence regarding epidemiology, clinical consequences, and management. Chest. 2017;152(6):1318-1326.
39. Macrea M, Oczkowski S, Rochwerg B, et al. Long-term noninvasive ventilation in chronic stable hypercapnic chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline. American journal of respiratory and critical care medicine. 2020;202(4):e74-e87.
40. Nair S, Paul T, Mehta AA, Haridas N, Kunoor A, Sudhakar N. Prevalence of overlap syndrome in patients with obstructive sleep apnea in a quaternary care center of Kerala. Indian Journal of Public Health. 2022;66(Suppl 1):S12-S16.
41. Redolfi S, Yumino D, Ruttanaumpawan P, et al. Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. American journal of respiratory and critical care medicine. 2009;179(3):241-246.
42. Poulain M, Doucet M, Major GC, et al. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. Cmaj. 2006;174(9):1293-1299.
43. Chaouat A, Weitzenblum E, Kessler R, et al. Sleep-Related O2 Desaturation and Daytime Pulmonary Haemodynamics in COPD Patients With Mild Hypoxaemia. Chest. 1998;114(6):A-22 (1)-A-22 (1).
44. Steveling EH, Clarenbach CF, Miedinger D, et al. Predictors of the overlap syndrome and its association with comorbidities in patients with chronic obstructive pulmonary disease. Respiration. 2014;88(6):451-457.
45. Kim V, Han MK, Vance GB, et al. The chronic bronchitic phenotype of COPD: an analysis of the COPDGene Study. Chest. 2011;140(3):626-633.
46. He B-T, Lu G, Xiao S-C, et al. Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD. Thorax. 2017;72(3):256-262.
47. Medicine AOSATFotAAoS. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine. 2009;5(3):263-276.
48. Silva MdS, Poyares D, Silva LO, et al. Associations of the severity of obstructive sleep apnea with age-related comorbidities: a population-based study. Frontiers in Neurology. 2022;13:802554.
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