Examining the need for positive airway pressure in patients with COPD-OSA overlap

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) - obstructive sleep apnea (OSA) overlap is prevalent in patients with either COPD or OSA. Patients with COPD-OSA overlap are likely to have different pathophysiological endotypes and thus different clinical phenotypes which are likely to lead to challenges in the management of this heterogenous population. This report examines current evidence for positive airway pressure therapy in COPD-OSA overlap, with an emphasis on outcomes and guidance gaps. AREAS COVERED: Current data outlining the risks of COPD-OSA overlap are explored with a particular emphasis on cardiovascular morbidity and mortality. Currently available treatment, the evidence around this and national and international guidelines are considered. Novel trials are likely to bring further clarity in managing this patient population. EXPERT OPINION: It is clear that COPD-OSA overlap presents a synergistic profile leading to poorer outcomes compared to each individual condition alone. Moreover, patients with overlap syndrome are likely to have increased morbidity and mortality. In the symptomatic patient, continuous positive airway pressure (CPAP) therapy should be offered. However, the benefit in the asymptomatic population remains to be elucidated from future trials. There is little evidence beyond CPAP in this population and further evidence and research is needed in this field.