Barbara Phillips: MD, MPH, FCCP: Sleep Apnea Comorbidities

Sleep apnea is associated with a host of comorbidities, but its overlap with specific conditions is of high importance and concern for Barbara Phillips, MD, MPH, FCCP.

While at this year’s CHEST meeting in San Antonio, TX, Phillips sat down with MD Magazine^® and highlighted the main comorbidities associated with sleep apnea, connecting the overlap among asthma, chronic obstructive pulmonary disease (COPD), bronchitis, emphysema, and obesity.

MD Mag: What are the most common comorbidities associated with sleep apnea? Are other pulmonological conditions common in patients?

Phillips: As you know, obesity is an important risk factor for sleep apnea. You don’t—I want to say it again—you don’t have to be heavy for sleep apnea. You could just be old, or genetically predisposed, or have big tonsils, or be Asian, or whatever.

But, obesity is a hugely important and 1 of the few modifiable risk factors for sleep apnea. The comorbidities that go with obesity tend be seen in sleep apnea. By far and away, the 2 most prevalent [comorbidities] are diabetes and hypertension, which are associated, as you know, with obesity.

It turns out though, because your question was specifically, ‘What other pulmonary conditions are associated with sleep apnea?’ that asthma is as well. It turns out that obesity is also a risk factor asthma, and there all kinds of reasons for that—from, simply, the mechanical compression of the lungs and the airways by obesity, to the little things we can’t see that are inflammatory mediators that are secreted by fat tissue.

Asthma tends to be common in people with obstructive sleep apnea, and there is now an emerging body of evidence that says, ‘A patient who has both obstructive sleep apnea and asthma will do better if that person uses CPAP [continuous positive airway pressure].’

COPD, chronic obstructive pulmonary disease, bronchitis, emphysema—we’ll all lump it all together—COPD, which certainly is a bread and butter pulmonary disease, also has significant overlap with obstructive sleep apnea. In fact, the combination of COPD and sleep apnea is called the overlap syndrome.

There is now pretty good data that has come largely from Spain, showing that if a patient with COPD and sleep apnea uses CPAP, that person is less likely to die—which is kind of an important outcome. Also—almost equally important to the clinician and even some of the patients is—that patient is less likely to have a COPD exacerbation.

COPD is a chronic, miserable condition, but the worst part of it for the patients is their exacerbations. When the disease gets so bad, then something has to happen. They have to take an antibiotic, or they have to be admitted to the hospital, or they have to be in the intensive care unit. That is where the misery, and that is where the cost of management of COPD comes in. It may be that each COPD exacerbation also does more, further, acute damage to the lungs and worsen the COPD.

We do see a lot of overlap with COPD and asthma in people with obstructive sleep apnea.

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