Abstract：
UNASSIGNED: The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), or the overlap syndrome, is common and associated with a distinct pattern of nocturnal hypoxemia and worse clinical outcomes than either disease alone. Consequently, identifying who and how to treat these patients is essential.
UNASSIGNED: Treatment is recommended in all patients with OSA and symptoms or systemic hypertension, but determining symptoms attributable to OSA can be challenging in patients with COPD. Treatment should be considered in asymptomatic patients with moderate to severe OSA and COPD with pulmonary hypertension and comorbid cardiovascular and cerebrovascular disease, especially if marked hypoxic burden. CPAP is effective, but in patients with the overlap syndrome and daytime hypercapnia, high-intensity noninvasive ventilation aiming to lower PaCO2 may have additional benefits. Additionally, in those with severe resting daytime hypoxemia, supplemental oxygen improves survival and should be added to positive airway pressure. The role of alternative non-positive airway pressure therapies in the overlap syndrome needs further study.
UNASSIGNED: Both COPD and OSA are heterogeneous disorders with a wide range of disease severity and further research is needed to better characterize and prognosticate patients with the overlap syndrome to personalize treatment.
UNASSIGNED: Treatment is recommended in all patients with OSA and symptoms or systemic hypertension, but determining symptoms attributable to OSA can be challenging in patients with COPD. Treatment should be considered in asymptomatic patients with moderate to severe OSA and COPD with pulmonary hypertension and comorbid cardiovascular and cerebrovascular disease, especially if marked hypoxic burden. CPAP is effective, but in patients with the overlap syndrome and daytime hypercapnia, high-intensity noninvasive ventilation aiming to lower PaCO2 may have additional benefits. Additionally, in those with severe resting daytime hypoxemia, supplemental oxygen improves survival and should be added to positive airway pressure. The role of alternative non-positive airway pressure therapies in the overlap syndrome needs further study.
UNASSIGNED: Both COPD and OSA are heterogeneous disorders with a wide range of disease severity and further research is needed to better characterize and prognosticate patients with the overlap syndrome to personalize treatment.
摘要：
■慢性阻塞性肺疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）并存，或者重叠综合征，是常见的，并与夜间低氧血症的独特模式和更差的临床结果比任何一种疾病单独。因此,确定谁以及如何治疗这些患者至关重要。
■建议对所有患有OSA和症状或全身性高血压的患者进行治疗，但是确定可归因于OSA的症状在COPD患者中可能具有挑战性。对于中度至重度OSA和COPD合并肺动脉高压和合并心脑血管疾病的无症状患者，应考虑治疗。特别是如果有明显的缺氧负担。CPAP是有效的，但在重叠综合征和日间高碳酸血症患者中，旨在降低PaCO2的高强度无创通气可能有额外的益处。此外,在那些有严重静息日间低氧血症的人中，补充氧气可提高生存率，应加入气道正压通气。替代非气道正压治疗在重叠综合征中的作用需要进一步研究。
■COPD和OSA均为异质性疾病，具有广泛的疾病严重程度，需要进一步研究以更好地表征和预测重叠综合征患者的个性化治疗。
■建议对所有患有OSA和症状或全身性高血压的患者进行治疗，但是确定可归因于OSA的症状在COPD患者中可能具有挑战性。对于中度至重度OSA和COPD合并肺动脉高压和合并心脑血管疾病的无症状患者，应考虑治疗。特别是如果有明显的缺氧负担。CPAP是有效的，但在重叠综合征和日间高碳酸血症患者中，旨在降低PaCO2的高强度无创通气可能有额外的益处。此外,在那些有严重静息日间低氧血症的人中，补充氧气可提高生存率，应加入气道正压通气。替代非气道正压治疗在重叠综合征中的作用需要进一步研究。
■COPD和OSA均为异质性疾病，具有广泛的疾病严重程度，需要进一步研究以更好地表征和预测重叠综合征患者的个性化治疗。
