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已发表论文
慢性阻塞性肺疾病与阻塞性睡眠呼吸暂停共存：从病理生理学到临床并发症
Authors Wei X, Zhang X, Wang S, Jiang G, Yu H, Fu B, Bai L, Sun F, Hu S, Shi L
Received 2 July 2025
Accepted for publication 8 November 2025
Published 15 December 2025 Volume 2025:20 Pages 4031—4059
DOI https://doi.org/10.2147/COPD.S550739
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jill Ohar
Xiaotong Wei,1 Xiaoyu Zhang,2 Siping Wang,1 Guolu Jiang,1 Hongpeng Yu,2 Bowen Fu,1 Lina Bai,1 Feng Sun,1 Shaodan Hu,2 Li Shi2
1College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, People’s Republic of China; 2Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, 130021, People’s Republic of China
Correspondence: Li Shi, Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, People’s Republic of China, Email shili0648@163.com Shaodan Hu, Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, People’s Republic of China, Email 734168300@qq.com
Background: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two common chronic respiratory diseases. Their co-existence forms overlap syndrome (OVS), a distinct clinical entity that imposes a dual burden on patients due to its unique pathophysiological mechanisms and significant clinical implications.
Purpose: This narrative review describes the consequences of OVS by tracing its pathophysiological from molecular mechanisms to clinical phenotypes, including non-cardiovascular complications. The primary aim is to synthesize this knowledge into a conceptual framework to guide future therapeutic development.
Methods: We searched electronic databases including Pubmed, Web of Science and Google Scholar for relevant studies and academic articles discussing OSA-COPD overlap.
Results: OVS demonstrates a high population prevalence, with distribution influenced by factors such as gender, age, COPD-specific phenotypes, and OSA severity. Pathogenically, factors including smoking and obesity collectively contribute to significant airflow limitation (AFL) through impaired respiratory control, reduced ventilatory drive, and multi-level airway narrowing. The characteristic chronic hypoxia and persistent AFL drive disease progression by triggering systemic inflammation, oxidative stress, and autonomic dysfunction. Consequently, the clinical presentation of OVS is more complex and severe than that of either disease alone, characterized by profound hypoxemia and prevalent hypercapnia. Beyond the core respiratory impairments, which predispose patients to major cardiovascular events, OVS drives a range of extrapulmonary manifestations. These include metabolic derangements, hematological alterations, neuropsychiatric complications, Vitamin D Deficiency, osteoporosis, retinal vascular tortuosity, erectile dysfunction (ED), and postural control, potentially fueled by persistent systemic inflammation and chronic hypoxia. This multisystem involvement. This multisystem involvement collectively contributes to a significantly worsened clinical prognosis.
Conclusion: Understanding the progression from localized AFL to systemic injury is essential for clarifying the full burden of OVS, particularly as it relates to its various comorbidities. Current evidence offers a basis for improving early identification and diagnosis of both the primary condition and its associated comorbid states. Future research should prioritize the development of personalized management strategies that address the specific risks of different comorbidities.
Keywords: obstructive apnea syndrome, chronic obstructive pulmonary disease, overlap syndrome, metabolic disease, vitamin D deficiency, retinal vascular tortuosity
1College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, 130117, People’s Republic of China; 2Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, 130021, People’s Republic of China
Correspondence: Li Shi, Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, People’s Republic of China, Email shili0648@163.com Shaodan Hu, Department of Pneumology, Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, People’s Republic of China, Email 734168300@qq.com
Background: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two common chronic respiratory diseases. Their co-existence forms overlap syndrome (OVS), a distinct clinical entity that imposes a dual burden on patients due to its unique pathophysiological mechanisms and significant clinical implications.
Purpose: This narrative review describes the consequences of OVS by tracing its pathophysiological from molecular mechanisms to clinical phenotypes, including non-cardiovascular complications. The primary aim is to synthesize this knowledge into a conceptual framework to guide future therapeutic development.
Methods: We searched electronic databases including Pubmed, Web of Science and Google Scholar for relevant studies and academic articles discussing OSA-COPD overlap.
Results: OVS demonstrates a high population prevalence, with distribution influenced by factors such as gender, age, COPD-specific phenotypes, and OSA severity. Pathogenically, factors including smoking and obesity collectively contribute to significant airflow limitation (AFL) through impaired respiratory control, reduced ventilatory drive, and multi-level airway narrowing. The characteristic chronic hypoxia and persistent AFL drive disease progression by triggering systemic inflammation, oxidative stress, and autonomic dysfunction. Consequently, the clinical presentation of OVS is more complex and severe than that of either disease alone, characterized by profound hypoxemia and prevalent hypercapnia. Beyond the core respiratory impairments, which predispose patients to major cardiovascular events, OVS drives a range of extrapulmonary manifestations. These include metabolic derangements, hematological alterations, neuropsychiatric complications, Vitamin D Deficiency, osteoporosis, retinal vascular tortuosity, erectile dysfunction (ED), and postural control, potentially fueled by persistent systemic inflammation and chronic hypoxia. This multisystem involvement. This multisystem involvement collectively contributes to a significantly worsened clinical prognosis.
Conclusion: Understanding the progression from localized AFL to systemic injury is essential for clarifying the full burden of OVS, particularly as it relates to its various comorbidities. Current evidence offers a basis for improving early identification and diagnosis of both the primary condition and its associated comorbid states. Future research should prioritize the development of personalized management strategies that address the specific risks of different comorbidities.
Keywords: obstructive apnea syndrome, chronic obstructive pulmonary disease, overlap syndrome, metabolic disease, vitamin D deficiency, retinal vascular tortuosity