Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Obstructive Sleep Apnoea Syndrome and Overlap Syndrome

Abstract

: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea syndrome (OSAS) are among the most prevalent chronic respiratory disorders. Accumulating data suggest that there is a significant burden of cardiovascular disease (CVD) in patients with COPD and OSAS, affecting negatively patients’ quality of life and survival. Overlap syndrome (OS), i.e. the co-existence of both COPD and OSAS in the same patient, has an additional impact on cardiovascular system multiplying the risk of morbidity and mortality. The underlying mechanisms for the development of CVD in patients with either OSAS or COPD and OS are not entirely elucidated. Several mechanisms, in addition to smoking and obesity, may be implicated, including systemic inflammation, increased sympathetic activity, oxidative stress and endothelial dysfunction. Early diagnosis and proper management of these patients might reduce the cardiovascular risk and lead to improved survival. In this review, we summarize the current knowledge regarding epidemiological aspects, pathophysiological mechanisms and present point- to- point specific associations between COPD, OSAS, OS and components of CVD, namely, pulmonary hypertension, coronary artery disease, peripheral artery disease and stroke.

Burden of Comorbidities in Patients with OSAS and COPD-OSAS Overlap Syndrome

“…In the case of OS these patho-physiological phenomena might all simultaneously emerge resulting in the presence and/or development of co-existing diseases [10], as it is shown in our study. Regarding pathogenesis of CVD, both COPD and OSAS are linked with systemic inflammation, oxidative stress, and hyper-coagulopathy, which predispose to endothelial dysfunction and atherosclerosis [1,30]. Moreover, COPD via smoking and OSAS via obesity could further promote development of CVD [1].…”

“…Regarding pathogenesis of CVD, both COPD and OSAS are linked with systemic inflammation, oxidative stress, and hyper-coagulopathy, which predispose to endothelial dysfunction and atherosclerosis [1,30]. Moreover, COPD via smoking and OSAS via obesity could further promote development of CVD [1]. All these taken together multiply the risk of CVD in patients with OS.…”

“…Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are highly prevalent in the general population, with an occurrence of approximately 10% for each [1]. Nevertheless, both are frequently under-diagnosed, leading to several medical complications and increased social and financial burden [2,3].…”

Anxiety and Comorbidities Differences in Adults with Chronic Pulmonary Diseases: Serbian Single Center Experience

“…Moreover, chronic pulmonary heart disease and pulmonary hypertension often develop in advanced COPD. In addition to endothelial dysfunction, pulmonary specific mechanisms also play a role in the development of pulmonary hypertension [ 26 ]. These mechanisms are vasoconstriction due to hypoxemia in advanced COPD or emphysema due to the destruction of the alveolar-capillary membrane, smoking which causes inflammation of the vascular wall.…”

“…These mechanisms are vasoconstriction due to hypoxemia in advanced COPD or emphysema due to the destruction of the alveolar-capillary membrane, smoking which causes inflammation of the vascular wall. All this leads to the worsening of gas exchange, dyspnea, load on the right heart and heart failure [ 26 ]. Such observations might be to the certain degree in line with our study findings, particularly increased values of cardiovascular and respiratory symptoms in patients with COPD (without emphysema phenotype).…”