Bonnie and Clyde, the Overlap Syndrome

This chapter reviews the “overlap syndrome” between obstructive sleep apnea and chronic obstructive pulmonary disease. The authors discuss the potential mechanisms implicated in these interactions and the bidirectional influences that the entities exert on one another. Overlap syndrome is a highly prevalent condition associated with increased morbidity and mortality. It has been associated with a high recurrence of acute exacerbations of COPD compared to isolated COPD. The chapter also reviews the interactions of overlap syndrome during sleep and the clinical consequences of untreated overlap syndrome. Therapeutic options and the benefits of continuous positive airway pressure are also reviewed. The mortality benefits of treating overlap syndrome with CPAP have been extensively demonstrated but the role of noninvasive positive-pressure ventilation in the treatment of overlap syndrome remains poorly established.