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Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea

Overlaps in Pathophysiology, Systemic Inflammation, and Cardiovascular Disease

¹ Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland

Correspondence and requests for reprints should be addressed to Walter T. McNicholas, M.D., Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. E-mail: walter.mcnicholas{at}ucd.ie

ABSTRACT

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome represent two of the most prevalent chronic respiratory disorders in clinical practice, and cardiovascular diseases represent a major comorbidity in each disorder. The two disorders coexist (overlap syndrome) in approximately 1% of adults but asymptomatic lower airway obstruction together with sleep-disordered breathing is more prevalent. Although obstructive sleep apnea syndrome has similar prevalence in COPD as the general population, and vice versa, factors such as body mass index and smoking influence relationships. Nocturnal oxygen desaturation develops in COPD, independent of apnea/hypopnea, and is more severe in the overlap syndrome, thus predisposing to pulmonary hypertension. Furthermore, upper airway flow limitation contributes to nocturnal desaturation in COPD without apnea/hypopnea. Evidence of systemic inflammation in COPD and sleep apnea, involving C-reactive protein and IL-6, in addition to nuclear factor-B–dependent pathways involving tumor necrosis factor- and IL-8, provides insight into potential basic interactions between both disorders. Furthermore, oxidative stress develops in each disorder, in addition to activation and/or dysfunction of circulating leukocytes. These findings are clinically relevant because systemic inflammation may contribute to the pathogenesis of cardiovascular diseases and the cell/molecular pathways involved are similar to those identified in COPD and sleep apnea. However, the pathophysiological and clinical significance of systemic inflammation in COPD and sleep apnea is not proven, and thus, studies of patients with the overlap syndrome should provide insight into the mechanisms of systemic inflammation in COPD and sleep apnea, in addition to potential relationships with cardiovascular disease.

Key Words: chronic obstructive pulmonary disease • obstructive sleep apnea • hypoxia • systemic inflammation • cardiovascular disease