Fri. Dec 1st, 2023
Overlap Syndrome: how obstructive sleep apnea and COPD coexistOverlap Syndrome: how obstructive sleep apnea and COPD coexist

An introduction to COLDOSA

In the medical field Syndrome, acronyms are very popular. If you have the chronic obstructive pulmonary disease (COPD), you may see your doctor to determine if you require long-term oxygen treatment or continuous positive airway pressure (CPAP) (LTOT). We may gain valuable time throughout our demanding workload by employing acronyms. Regrettably, when medical terminology interferes with a patient’s comprehension of their illness, it may cause a lot of confusion.

COLDOSA, the mother of all medical abbreviations (Chronic Obstructive Lung Disease and Obstructive Sleep Apnoea). Fortunately, we can simplify this for our perplexed patients by naming it Overlap Syndrome, or OS.

When a patient has both chronic obstructive pulmonary disease and obstructive sleep apnea, it is referred to as overlap syndrome or COLDOSA. When these disorders are present together, the amount of oxygen in the blood during sleep significantly decreases, increasing the risk of impairment and death.

What is the overlap between COPD and OSA?

The term “overlap” may imply that COPD sufferers share some traits, however, in this instance, the term is misleading. Instead, these are two widely prevalent, distinct disorders that each have a distinctive effect on your airways. The “overlap” in a person with both illnesses refers to how the conditions combine to raise the risks above and above what would be anticipated for each ailment.

In COPD, which is typically brought on by smoking, your lungs’ alveoli gradually get blocked off from airflow as a result of persistent inflammation. Simply put, breathing in smoke or other toxic gases irritates the lungs, which results in an irreversible constriction of the airways and makes breathing more difficult. The mortality and morbidity rates for COPD are high.

Another prevalent problem is obstructed sleep apnoea (OSA), which occurs when the throat’s muscles relax while you sleep and cause your airway to occasionally close. This is accompanied by loud snoring and rapidly decreasing oxygen levels while you sleep, which finally causes a startling wakeup. This raises the risk of high blood pressure, heart disease, and stroke while also causing disrupted sleep and increased daytime drowsiness.

Both COPD and OSA are extremely prevalent diseases; in the UK, 1.5 million people have been diagnosed with OSA and 1.17 million with COPD, respectively. The real prevalence of both COPD and OSA in individuals over 40 is considered to be between 5 and 10%; this figure only represents the number of patients who have received a diagnosis.

Even if we disregard the common risk factors, like smoking and aging, the likelihood that a patient would have both illnesses is still high—roughly 1 in 200 persons over the age of 40.

How these conditions work together to damage your health

The muscles in our upper airway, diaphragm, and chest wall relax as we sleep, especially during the rapid eye movement (REM) phase. Often, this doesn’t pose a big issue, and we can still get a good night’s sleep.

This deep sleep is very difficult for people with OSA because, during REM sleep, the relaxed upper airway fully closes. This is brought on by increased throat pressure from conditions including obesity and peripheral edema, as well as constricted airways from nasal congestion or larger tonsils. You become unable to breathe when the airway closes, which results in hypoxia (low oxygen levels) until the brain’s sensors kick in and awaken you. As a result, there are frequent instances of low oxygen levels throughout the night, arousal, and disrupted sleep. It is hypothesized that this may enhance the release of catecholamines, which will increase pulmonary arterial pressure, create hypertension, and result in right-sided heart failure.

Individuals with COPD also experience comparable issues with sleep quality. As a result of lung scarring and airway constriction, the lungs are unable to adjust for the chest wall’s decreased mobility during REM sleep, rendering breathing inefficiently. 70% of COPD patients are reported to have a reduction in oxygen levels during the night, and almost half of the patients with COPD report having trouble falling or staying asleep.

When OSA and COPD interact, it causes even more interrupted sleep and frequently occurs with nocturnal hypoxemia or low oxygen levels at night. For unfathomable reasons, these impacts work in concert, and the overall hazards outweigh the individual ones.

Short-term symptoms of nocturnal hypoxemia include weariness, lack of focus, and daytime somnolence (sleepiness). Yet, the long-term consequences of persistent nocturnal hypoxemia are where the actual danger lies. This extended reduction in oxygen levels stimulates the body’s inflammatory response, which is repeated several times each night and eventually results in a chronic state of inflammation. Inflammation in this stage can result in several disorders, including:

  • Hypertension
  • Stroke
  • Pulmonary Hypertension
  • Right-sided heart failure
  • Arrhythmias such as atrial fibrillation
  • Cognitive impairment due to its effect on mammillary bodies
  • Increased risk of type 2 diabetes mellitus

When handled incorrectly, this can potentially spiral into a vicious circle. Fluid accumulates in the body as a result of right-sided heart failure, which can enhance the risk and severity of OSA by adding pressure in the area around the throat. This might then aggravate the condition of chronic inflammation and cause heart failure.

Poor-quality sleep has long-term effects as well. Those who have trouble sleeping are more prone to experience anxiety and despair, and getting too little sleep raises the risk of:

  • Mania
  • Psychosis
  • Road traffic and workplace accidents
  • An underproductive workforce
  • Suicide

The burden on these patients’ mental health—who are already at risk for sadness and anxiety due to COPD—increases as their sleep quality deteriorates.

By admin

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