What You Need to Know About COPD, OSA, and Overlap Syndrome

Authored by The Rx Advocates, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS


Most people do not think about breathing all that much; their body just does its job. But for some people, breathing properly is always on their minds. Someone who is affected by COPD, OSA, or both has a hard time breathing.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea are very common breathing issues. Over 16.4 million people in the US have been diagnosed with COPD. It is estimated that 18 million Americans have obstructive sleep apnea (OSA). 

It is estimated that 10-15% of people with COPD also have OSA. Having both is called overlap syndrome.

What is Chronic Obstructive Pulmonary Disease (COPD)?

COPD is a group of diseases that cause airflow blockage and breathing problems. There is no cure for COPD. It can be treated, but millions of people have undiagnosed COPD and are not getting the help they need.

Chronic bronchitis and emphysema are the two most common diseases with COPD. Some doctors believe that asthma should be included in COPD, but there is disagreement on the subject.

Chronic Bronchitis

Bronchitis is the inflammation of the bronchi. The bronchi are the tubes that allow air to go into the lungs. 

Chronic bronchitis is long-term inflammation of the bronchi. People with chronic bronchitis may have episodes when symptoms get worse, called acute bronchitis.

Symptoms of chronic bronchitis include:

  • Wheezing
  • Chest discomfort
  • Coughing up mucus
  • Cough, often called a smoker’s cough
  • Bluish fingernails, lips, and skin because of lower oxygen levels
  • Shortness of breath, especially with physical activities
  • A whistling or squeaky sound when breathing
  • Swelling in ankles, feet, or legs (in severe cases)
  • Lower muscle weakness (in severe cases)

Long-term exposure to irritants that damage the lungs and airways is the cause of chronic bronchitis. In the US, cigarette smoke is the main cause. Around 75% of people who have chronic bronchitis smoke or used to smoke. Other lung irritants that can contribute to chronic bronchitis include:

  • Secondhand smoke
  • Air pollution
  • Chemical fumes
  • Environment or workplace dust


Emphysema affects the tiny air sacs in the lungs called alveoli. When a person breathes in, the alveoli fill up like balloons. When someone breathes out, they deflate. 

Emphysema damages the alveoli. The walls between the alveoli are weakened or destroyed. This can lead to fewer and larger air sacs, making it harder for oxygen to get into the bloodstream.

Alveoli damage from emphysema is permanent. Once someone has emphysema, they will have to deal with it for the rest of their life. There are treatments that can help.

Early symptoms of emphysema are similar to chronic bronchitis:

  • Shortness of breath
  • Tightness in the chest
  • Wheezing
  • Whistling or squeaky sound when breathing
  • Chronic cough with mucus

Late-stage symptoms of emphysema include:

  • Fatigue and loss of energy
  • Weight loss
  • Reduced appetite
  • Frequent lung infections
  • Anxiety and depression
  • Sleep problems
  • Blue-tinged fingernails and lips from low oxygen levels

The cause of emphysema is also similar to chronic bronchitis. Air pollutants at home or work can contribute. The number one cause of emphysema is smoking.

What is Obstructive Sleep Apnea (OSA)?

Sleep apnea is abnormal breathing while sleeping. Those with sleep apnea have extended pauses in their breath when they sleep. It is similar to holding one’s breath, but not on purpose. 

Obstructive sleep apnea happens when the airway at the back of the throat becomes blocked. Many cases of OSA go undiagnosed. Many people are unaware of the problem because they are asleep. The most common way for OSA to be diagnosed is someone telling the person about their chronic snoring.

Symptoms of sleep apnea include:

  • Loud snoring that includes gasping or snorting
  • Morning sore throat or dry mouth
  • Frequent need to wake up to go to the bathroom
  • Excessive daytime sleepiness
  • Morning headaches
  • Irritability

The causes of OSA include:

  • The size of a person’s neck, jaw, tongue, tonsils, and other tissues at the back of the throat can interfere with airflow.
  • Being overweight is a leading cause of OSA. Obesity contributes to the narrowing of the airway.
  • The use of sedative medication and alcohol causes tissue in the throat to relax, making airway obstruction more likely.
  • A person sleeping on their back makes it easier for airways to be obstructed.
  • A family history of OSA increases the chances of developing OSA.
  • Heavy smokers have been found to have a higher rate of OSA than non-smokers.

What is Overlap Syndrome?

Overlap syndrome is when a person has both COPD and OSA. Both diseases are common, so it is not surprising that someone can have both. One condition does not cause the other, but having both raises the risk of mortality.

Having OSA does not mean you will get COPD, and having COPD does not mean you will develop OSA. Since they do both affect the airways, they can happen in the same person. Smoking is also a factor that contributes to both diseases. 

Long Term Risks of COPD, OSA, and Overlap Syndrome

Both COPD and OSA cause the body to be deprived of oxygen. This is called hypoxia. This can lead to the following health problems:

  • Abnormal heartbeat
  • High blood pressure
  • Pulmonary hypertension (high blood pressure in the lungs)
  • Stroke

Having overlap syndrome increases the risks of those other health conditions. Specifically, patients with overlap syndrome had a significantly higher incidence of pulmonary hypertension, 86%, compared to 16% in those with only OSA. 

Treating COPD, OSA, and Overlap Syndrome

The treatments for COPD and OSA are different. If someone has overlap syndrome, they must treat both COPD and OSA.

OSA is usually treated by using a continuous positive airway pressure (CPAP) machine when they are sleeping. This device pushes air through a mask into the airway to keep it open. Losing weight can help resolve some cases of OSA if that is a contributing factor.

COPD can not be reversed, but it can be managed to relieve some symptoms. 

Often people with COPD use medications to help improve symptoms. Common medications prescribed for COPD include:

Do You Need Help Paying for Your COPD Medications?

COPD, OSA, and overlap syndrome are severe diseases. They could lead to additional health concerns. When someone has overlap syndrome, they must treat both OSA and COPD.

COPD is not curable, it will not go away because the lungs have been permanently damaged. It can be treated with medications to help provide relief from symptoms.

Those medications can be expensive, and they will be needed for the rest of your life. The Rx Advocates help people save money on their prescriptions every day by working with Patient Assistance Programs.

For more information on how we could help you, contact us today.

Call Now Button