COPD and Sleep Apnea Often Coexist

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Sleep Apnea

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If you have chronic obstructive pulmonary disorder (COPD), it's likely that you may also have obstructive sleep apnea (OSA), a sleep disorder characterized by episodes of breathing pauses during sleep. Once thought to have no underlying relationship, current research has shown that there is a pathophysiological link between the two conditions, known as COPD-OSA overlap syndrome. Having both disorders at the same time can be challenging. If you have COPD and suspect you may have sleep apnea, read on.

COPD and Sleep Apnea

Both COPD and OSA are highly prevalent as single conditions in the general population, but there is also a linking of the conditions, known as comorbidity. In fact, anywhere from nine to 11 percent of people with COPD also have OSA. When appearing together, COPD and OSA may actually exacerbate each other, and the combination is known as overlap syndrome (OS).

COPD has two branches: emphysema and chronic bronchitis, and researchers have learned that the low body mass index (BMI) and increased lung volume associated with emphysema may actually be protective against OSA, whereas the high BMI and decreased lung volume associated more with chronic bronchitis may actually promote OSA.

Both COPD and OSA are associated with high levels of systemic inflammation and low levels of oxygen in the blood (hypoxia), as well as pulmonary hypertension, a type of high blood pressure affecting the blood vessels within and around the lungs. When combined in OS, the hypoxia could be life-threatening. It's important to recognize the symptoms of OS early so that other cardiac comorbidities don't progress.

Symptoms

OSA occurs when your throat muscles, including your tongue, collapse during sleep and block your airway. Because many people who suffer from OSA are overweight, they often have an enlarged tongue and soft palate and/or excess fat in their throat area.

During an apneic episode, you may stop breathing for up to 10 seconds or more and, as your blood oxygen levels drop, you may awaken abruptly with a loud gasp or snort. The number of apneic events you experience may be as high as 20 to 30 per night or more, and the effects may lead to serious health complications. Other symptoms of sleep apnea include:

  • Excessive daytime sleepiness
  • Morning headache
  • Sore throat
  • Changes in your personality
  • Mental deterioration
  • Behavioral disorders
  • Bedwetting
  • Impotence
  • Obesity
  • Complaints from your partner that you snore too loudly

Risk Factors

Both COPD and OSA are independent risk factors for heart problems that may include irregular heartbeat, high blood pressure, heart attack, and stroke, and their coexistence in OS may further increase these cardiovascular risks. This makes early identification of OSA in people with COPD extremely important.

People with overlap syndrome may also have:

Aside from having COPD, the following risk factors may increase your risk of developing sleep apnea:

  • Being male
  • Being older
  • Being African-American, Hispanic or Pacific Islander
  • Being obese
  • Having a large neck circumference (17" or more for men and 16" or more for women)
  • Drinking alcohol
  • Smoking
  • Associated medical conditions, such as gastroesophageal reflux disorder (GERD), diabetes, or polycystic ovary syndrome

Treatment

The focus of treatment for COPD/OSA will be different for the combination of the conditions than for either condition on its own. Non-surgical treatment options for OS usually includes a combination of the following:

Supplemental oxygen, although helpful for COPD alone, may exacerbate apneic episodes in those with OSA or OS.

If you are someone who cannot tolerate CPAP and your OSA is severe, you may want to discuss the following surgical options with your health care provider:

A Word From Verywell

If you have COPD and are having sleep issues, it's important to discuss this immediately with your doctor. Because COPD affects your blood oxygen levels throughout the day, having sleep apnea at night may make matters worse. You may be suffering from OSA and not be aware of it, especially if you live alone. Paying close attention to your sleep patterns and your daytime symptoms will help you recognize a potential problem.

If you think you may have OSA or, if your partner complains that your snoring is intense, visit your health care provider for an evaluation and more information.

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