COPD (chronic obstructive pulmonary disease) - OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

COPD-OSAHS overlap syndrome occurs in people who have both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea/hypopnoea syndrome (OSAHS). The combined effect of these conditions on ventilatory load, gas exchange, comorbidities and quality of life is greater than either condition alone.

Initial assessment for COPD-OSAHS overlap syndrome

When to suspect COPD-OSAHS overlap syndrome

Take a sleep history and assess people for COPD-OSAHS overlap syndrome if they have confirmed COPD with:

• features of OSAHS When to suspect OSAHS Be aware that there is a higher prevalence of OSAHS in people with any of the following conditions:
  • take a sleep history and assess people for OSAHS if they have 2 or more of the following features:
    • snoring
    • witnessed apnoeas
    • unrefreshing sleep
    • waking headaches
    • unexplained excessive sleepiness, tiredness or fatigue
    • nocturia (waking from sleep to urinate)
    • choking during sleep
    • sleep fragmentation or insomnia
    • cognitive dysfunction or memory impairment
  • obesity or overweight
  • obesity or overweight in pregnancy
  • treatment-resistant hypertension
  • type 2 diabetes
  • cardiac arrythmia, particularly atrial fibrillation
  • stroke or transient ischaemic attack
  • chronic heart failure
  • moderate or severe asthma
  • polycystic ovary syndrome
  • Down's syndrome
  • non-arteritic anterior ischaemic optic neuropathy (sudden loss of vision in 1 eye due to decreased blood flow to the optic nerve)
  • hypothyroidism
  • acromegaly
• or
• features of nocturnal hypoventilation such as:
  • waking headaches
  • peripheral oedema
  • hypoxaemia (arterial oxygen saturation less than 94% on air)
  • unexplained polycythaemia

Reference

1. NICE. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. NICE guideline NG202. Published August 2021.