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Review of the prevalence, pathogenesis and management of OSA-COPD overlap

  • Sleep Breathing Physiology and Disorders • Review
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Abstract

Purpose

OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in either disease state alone.

Methods

Electronic databases PUBMED and Google Scholar were searched for studies and academic papers that discussed OSA-COPD overlap. Relevant papers that discussed prevalence, pathophysiology, microbiome studies, treatment regimens and outcomes were included in this paper.

Results

High-risk patients with either COPD or OSA should be screened for overlap syndrome as part of routine clinical practice. Screening questionnaires can identify high-risk patients with COPD who may benefit from formal polysomnography. Patients with OSA who are aged over 40 with a significant smoking history or environmental exposures have an increased pre-test probability of obstructive airway disease. The potential roles of gastro-oesophageal reflux disease and lung-gut microbiome are evolving and merit further investigation. A tailored approach to reach a timely diagnosis and thus optimisation of both conditions are key to management. CPAP is the primary therapy for OSA; however, patients with more advanced COPD, with daytime hypercapnia or severe nocturnal desaturations, may benefit from bilevel positive airway pressure.

Conclusion

Increased awareness, access to timely investigations and initiation of therapy will improve overall outcomes in OSA-COPD overlap by reducing hospitalisations for exacerbations of COPD and improve mortality rates.

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Availability of data and material

All study references are freely available on electronic databases.

Code availability

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Authors and Affiliations

  1. Department of Respiratory Medicine, Galway University Hospital, Saolta University Hospital Group, Newcastle Road, Galway, Ireland

    M. Brennan, M. J. McDonnell, S. M. Walsh, F. Gargoum & R. Rutherford

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  1. M. Brennan
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  2. M. J. McDonnell
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  3. S. M. Walsh
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  4. F. Gargoum
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MB wrote the first draft of the manuscript and all subsequent drafts. RR was responsible for the original concept and reviewed and edited all drafts. MMD, SW and FG reviewed all drafts of the manuscript.

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Correspondence to M. Brennan.

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Brennan, M., McDonnell, M.J., Walsh, S.M. et al. Review of the prevalence, pathogenesis and management of OSA-COPD overlap. Sleep Breath 26, 1551–1560 (2022). https://doi.org/10.1007/s11325-021-02540-8

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  • DOI: https://doi.org/10.1007/s11325-021-02540-8

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