OSA and COPD overlap syndrome

Postgraduate Thesis uoadl:3405323 12 Read counter

Κατεύθυνση Διαταραχές της αναπνοής στον ύπνο - Εργαστηριακή και Κλινική Ιατρική του Ύπνου
Library of the School of Health Sciences
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Giannikos Georgios
Supervisors info:
Γεωργία Τρακαδά, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παρασκευή Κατσαούνου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σπυρίδων Ζακυνθινός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Σύνδρομο αποφρακτικής άπνοιας στον ύπνο και ΧΑΠ (OSA and COPD overlap syndrome)
Translated title:
OSA and COPD overlap syndrome
Introduction: Obstructive sleep apnea (OSA) is characterized by repeated episodes of complete or partial obstruction of the upper airway and is the most common breathing related sleep disorder. Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by chronic respiratory symptoms and progressively worsening of airflow obstruction. The simultaneous occurrence of obstructive sleep apnea and COPD in the same patient is common and defined the overlap syndrome (OS)
Aim: This literature review aims to summarize the most important information on the epidemiologic data, risk factors, clinical manifestations, pathophysiology, diagnosis, cardiovascular complications, and treatment of overlap syndrome.
Material and method: studies were searched in the Medline (Pubmed) database, taking into account the PRISMA guidelines (Preferred reported items for systematic reviews and meta-analysis). The keywords used in the search were: "overlap syndrome, obstructive sleep apnea, chronic obstructive pulmonary disease, cardiovascular disease, sleep," as well as combinations of keywords. Published articles were selected in the English language in the time period 1985 to 2023. In addition, the search was limited to studies involving adults only.
Results: The overlap syndrome is associated with more severe hypoxemia during sleep, an increased number of comorbidities and worse survival compared to patients with OSA or COPD alone. Patients with overlap syndrome more frequently experience pulmonary hypertension, right heart failure, atrial fibrillation, coronary artery disease, arterial hypertension, stroke, and metabolic syndrome. Mechanisms involved in the development of cardiovascular disease and pulmonary hypertension are systemic inflammation, increased sympathetic activity, endothelial dysfunction and oxidative stress. Also, OS patients without CPAP therapy have an increased risk of COPD exacerbation and hospitalization. Considering that patients with overlap syndrome have increased mortality due to cardiovascular and metabolic comorbidities, it is essential for clinicians to promptly evaluate patients with OSA or COPD for the possibility of overlap and provide effective treatment. The STOP-BANG questionnaire and nocturnal oximetry can be used to detect obstructive apneas in patients with COPD, but a polysomnography sleep study is necessary for the diagnosis of OS. Management of overlap syndrome requires treating both diseases simultaneously, with upper airway positive airway pressure (PAP) being the mainstay of therapy and the cornerstone of reducing the syndrome's cardiovascular risk and mortality. In addition, optimizing COPD treatment and implementing interventions such as smoking cessation for smokers and weight loss for obese patients are essential.
Conclusions: Patients with overlap syndrome present different clinical characteristics, different prognosis and require a different therapeutic approach compared to those with OSA or COPD. Considering the severe hypoxemia and increased cardiovascular risk experienced by patients with overlap syndrome, it is essential for clinicians to screen patients with COPD or OSA for overlap syndrome. Patients with a high clinical suspicion should be evaluated and treated for both diseases simultaneously. The overlap syndrome should be treated with the aim of preventing multiple arousals during sleep and improving the quality of life of patients, in order to reduce the risk of developing cardiovascular diseases and increase their survival. However, there is a need for more research in this topic, focusing mainly on phenotypically directed diagnostic and therapeutic approaches.
Main subject category:
Health Sciences
Overlap syndrome, Obstructive sleep apnea syndrome, Chronic obstructive pulmonary disease, Cardiovascular diseases
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