01 Oct Asthma and OSA overlap
Obstructive sleep apnoea (OSA) doesn’t just steal a good night’s rest—it can also worsen chronic respiratory diseases like asthma and COPD. These conditions already affect millions worldwide, and when they overlap with OSA, the impact can be significant.
People with asthma and OSA often struggle with poor symptom control. Night-time wheeze, cough, and breathlessness may actually reflect untreated sleep apnoea rather than uncontrolled asthma. Treating OSA in these patients has been linked to better asthma control and quality of life.
For COPD, the story is even more striking. The coexistence of COPD and OSA—known as the “overlap syndrome”—carries higher risks of exacerbations, hospitalisation, and even mortality. Evidence suggests that using CPAP (continuous positive airway pressure) not only improves sleep and oxygen levels, but can also reduce flare-ups and improve survival in overlap patients.
Shared risk factors such as obesity, smoking, and ageing mean these conditions often occur together. However, the interaction goes deeper: OSA contributes to intermittent hypoxaemia, oxidative stress, and inflammation, while asthma and COPD alter airway mechanics, increasing the risk of these apnoeas starting a cycle of clinical events.
Diagnosis requires a high index of suspicion. Patients with uncontrolled asthma or frequent COPD flare-ups should be screened for OSA, using sleep studies where possible. Treatment is most effective when managed by multidisciplinary teams combining respiratory and sleep expertise.
Much remains to be learned. Large trials are needed to confirm the long-term benefits of CPAP in asthma and COPD populations. For now, the message is clear: when sleep and breath collide, recognising and treating OSA can make a real difference.
References:
Owens RL, Macrea MM, Teodorescu M. The overlaps of asthma or COPD with OSA: A focused review. Respirology. 2017;22(6):1073–1083.
American Thoracic Society. Sleep Problems in Asthma and COPD (Patient Education Fact Sheet). 2018.