COPD and Sleep Apnea

Their coexistence is known as overlap syndrome

If you have chronic obstructive pulmonary disorder (COPD), you may also have obstructive sleep apnea (OSA), a sleep disorder characterized by episodes of paused breathing during sleep. Research has shown that there is a physiological link between the conditions, the combination (comorbidity) of which is known as COPD-OSA overlap syndrome (OVS).

A man undergoing a sleep apnea test

Jeff T. Green / Getty Images

While either of these issues can have its own impact on your health, each can exacerbate the other. Together, they can compound concerns such as decreased oxygen levels, cardiovascular issues, and more.

If you have COPD, early identification and treatment of OSA can help reduce these harmful health complications.

It is estimated that approximately 9% to 11% of people with COPD also have OSA.

Connections and Complications

OSA and COPD are linked in terms of causative risk factors and health complications.

COPD is an obstructive lung disease that includes emphysema and chronic bronchitis. With OSA, your tongue and throat muscles collapse during sleep and block your airway. Lung inflammation is a major contributor to both conditions, and systemic (body-wide) inflammation present with each increases the risk of OVS.

Further, researchers suggest that lung hyperinflation and the trapping of air in the lungs that occur with COPD can reduce the body's response to low oxygen during sleep, contributing to the development of OVS.

Serious health effects may develop with these respiratory diseases. COPD and OSA both cause hypoxia (low oxygen in the body's tissues) and hypoxemia (low oxygen in the blood).

COPD and OSA each increase the risk of heart disease, and their coexistence may further increase cardiovascular risks such as:

  • Arrhythmias (Irregular heartbeat)
  • High blood pressure
  • Heart attack
  • Stroke

People with overlap syndrome may also have:

When combined in COPD-OSA overlap syndrome, these health issues may be life-threatening.

Recognizing Sleep Apnea

Some of the symptoms of COPD and OSA overlap—excessive daytime sleepiness, generalized fatigue, trouble concentrating, and irritability. So if you have COPD, it is important to be on the lookout for additional signs of OSA.

Apneic episodes during sleep are the most distinctive symptom of OSA. During an apneic episode, you may stop breathing for up to 10 seconds or more. After an episode, you may awaken abruptly with a loud gasp or snort.

You or your partner might notice these episodes, as they interrupt your sleep. The number of apneic events you experience may be as high as 20 to 30 per hour of sleep or more.

Other symptoms of OSA include:

  • Snoring
  • Sore throat
  • Not feeling refreshed after eight to 10 hours of nighttime sleep
  • Morning headache
  • Bedwetting
  • Impotence

When you have COPD, apneic episodes may also be associated with shortness of and trouble catching your breath.

If you think that you might have sleep apnea, talk to your healthcare provider. You may need an overnight sleep study—a test commonly used to diagnose the condition.


The focus of treatment for COPD-OSA overlap typically includes strategies that are also used for OSA alone. A combination of treatments is common in managing a comorbidity.

Your healthcare provider may recommend the following for your COPD-OSA overlap treatment:

If your OSA is severe or does not improve with nonsurgical management, your practitioners may discuss the following procedures with you:

  • Uvulopalatopharyngoplasty (UPPP)
  • Laser-assisted uvulopalatoplasty (LAUP)
  • Gastric bypass surgery (when OSA is due to morbid obesity)
  • Tracheostomy
  • Jaw surgery

These procedures are invasive, entail a long recovery, and yield mixed results in terms of OSA symptom improvement. But, depending on your situation, surgery may be beneficial for you.

A Word From Verywell

If you have COPD and are having sleep issues, it's important to discuss this immediately with your healthcare provider. COPD can affect your blood oxygen levels and your heart—and sleep apnea 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 so you can have an evaluation and get started on treatment if you need it.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhu J, Zhao Z, Nie Q, et al. Effect of lung function on the apnea-hypopnea index in patients with overlap syndrome: a multicenter cross-sectional study. Sleep Breath. 2019; Nov 25.doi.10.1007/s11325-019-01961-w

  2. Voulgaris A, Archontogeorgis K, Papanas N, et al. Increased risk for cardiovascular disease in patients with obstructive sleep apnoea syndrome-chronic obstructive pulmonary disease (overlap syndrome). Clin Respir J. 2019;13(11):708-715.doi.10.1111/crj.13078

  3. Mcnicholas WT. COPD-OSA overlap syndrome: Evolving evidence regarding epidemiology, clinical consequences, and management. Chest. 2017;152(6):1318-1326.doi.10.1016/j.chest.2017.04.160

  4. Messineo L, Lonni S, Magri R, et al. Lung air trapping lowers respiratory arousal threshold and contributes to sleep apnea pathogenesis in COPD patients with overlap syndrome. Respir Physiol Neurobiol. 2020;271:103315. doi. 10.1016/j.resp.2019.103315

  5. Malhotra A, Schwartz AR, Schneider H, et al. Research priorities in pathophysiology for sleep-disordered breathing in patients with chronic obstructive pulmonary disease. An official American Thoracic Society research statementAm J Respir Crit Care Med. 2018;197(3):289–299. doi:10.1164/rccm.201712-2510ST

  6. Ho ML, Brass SD. Obstructive sleep apneaNeurol Int. 2011;3(3):e15. doi:10.4081/ni.2011.e15

Additional Reading

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.