Management of COPD-OSA Overlap Syndrome Beyond Standard Care

The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), known as overlap syndrome (OS), presents unique diagnostic and therapeutic challenges. Patients with overlap syndrome exhibit more severe hypoxemia, higher cardiovascular risk, and increased COPD exacerbations compared to those with either condition alone. While treatment with positive airway pressure (PAP) remains the cornerstone of OSA management, its role in patients with OS requires more sophisticated application, particularly in the presence of hypercapnia or poor PAP tolerance. The present review synthesizes current evidence on the pathophysiology, clinical presentation, and management of patients with overlap syndrome, emphasizing the limitations of standard care. Moreover, the utility of noninvasive ventilation, pharmacologic strategies beyond PAP, and tailored screening tools are explored. Finally, it highlights the need for a comprehensive, individualized approach to the management of patients with overlap syndrome and calls for further research to refine treatment algorithms and improve patient outcomes.