Chronic obstructive pulmonary disease (COPD) is a major worldwide disease and ranks as the third leading cause of death in the world—killing some 2.7 million people annually.
COPD is closely related to cigarette exposure in those who smoke or those who have secondhand exposure to smoke. Meanwhile, obstructive sleep apnea (OSA) is a steadily emerging disease and is closely related to obesity and snoring. OSA is estimated to affect from 9% to 26% of the population.9 According to the World Health Organization, obesity is expected to rise dramatically, and the association with OSA will likely result in a dramatic increase in this problem.
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Independent of one another, these conditions, directly and indirectly, contribute to tens of thousands of American deaths every year. However, these two diseases can occur in a comorbid relationship known as OLDOSA syndrome (obstructive lung disease and obstructive sleep apnea), also known as OVS (overlap syndrome). Together, their adverse effects can be even greater than their impact alone.
COPD is “a common preventable and treatable condition, distinguished by persistent airflow limitation that is usually progressive and associated with an intensified chronic inflammatory response in the airways and the lung to harmful particles or gases. Exacerbations add to the overall severity in individuals.”
COPD involves many pathological changes that occur in varying degrees depending on the seriousness and susceptibility to damage. These include inflammation, hypersecretion of mucus, variations in the lung parenchyma (leading to the formation of blebs and bullae), limitation of airflow, and increased air trapping and hyperinflation.
Obstructive Sleep Apnea
OSA involves repeated intermittent collapse of the upper airway and tongue, which blocks the opening of the pharynx and stops airflow. Often the person has loud snoring while asleep before having a sleep disturbance. To be considered apnea, the airflow must pause for at least 10 seconds.
When these events occur, the brain is stimulated and the stage of sleep changes (this is called an arousal). The brain signals muscle contractions to reopen the airway, while the person is having this event usually doesn’t “wake up” but continues to sleep and often snores loudly until the next episode of apnea.
The Continuous Positive Airway Pressure is the preferred initial treatment for OSA, also known as CPAP. Alternative treatment options include oral mandibular advancement devices (and mandibular advancement surgery), weight loss, avoidance of alcohol and sleeping pills, nasal sprays, and nasal surgery.
There are many possible reasons why COPD can either cause OSA or make it worse in patients already suffering from the disease, and vice versa. It appears that the OLDOSA patients have a greater risk of prolonged oxygen desaturation at night and more risk of pulmonary hypertension, right heart failure, and cor pulmonale than those who have one or the other disease.
Notably, mortality for patients with OLDOSA syndrome appears to be greater than patients suffering from only one of the conditions. One study looking at OSA patients found the mortality risks were multiplied sevenfold when COPD was a comorbid condition.15 In another study published in 2010, scientists examined outcomes data on patients with COPD versus those with OLDOSA covering a 9-year period. They found that in OLDOSA patients who were not treated with CPAP, all-cause mortality was 42.2%. In contrast, for COPD patients with no OSA, all-cause mortality was 24.2%.9
Treatment for OLDOSA
CPAP is the ideal treatment for OSA, and it appears that CPAP improves outcomes in OLDOSA patients. Marin et al. found that CPAP therapy in those with OLDOSA had an all-cause mortality of 31.6% compared to an all-cause mortality of 42.2% in the OLDOSA patients who were not treated with CPAP.