COPD and OSA –⁠ A Deadly Duo That Raises Five-Year Mortality by One-Third

No Smoking, No COPD –⁠ But Genes Still Matter

Mortality from COPD continues to rise, currently ranking as the third leading cause of death worldwide—after cardiovascular and cerebrovascular diseases. “Three and a half to four thousand patients die directly from COPD, but many more die with COPD—often from bronchogenic carcinoma or cardiovascular disease, as the risk factors overlap,” explains Assoc. Prof. MUDr. Norbert Pauk, Ph.D., Head of the Department of Pulmonology, 3rd Faculty of Medicine, Charles University, and Bulovka University Hospital.

Smoking accounts for the vast majority of cases (about 85%), while the remaining 15% are caused by exposure to harmful substances indoors and outdoors. “It’s absolutely crucial to understand that not every smoker develops COPD,” stresses Pauk. The disease affects only 40–50% of smokers who carry the relevant genetic predisposition.

COPD Affects Both Cachectic and Obese Patients

The insidious nature of COPD lies in its often asymptomatic course—manifesting only as a gradual decline in lung function. People with a sedentary lifestyle may not notice breathlessness until the disease is advanced. COPD also has visible physical manifestations: “Systemic inflammation leads to the loss of striated muscles, including respiratory muscles and the diaphragm, causing patients to lose muscle mass over the years and progressively lose weight. Cachexia is typical,” notes Pauk.

However, COPD does not always present with cachexia. When combined with OSA, it can also occur in overweight or obese individuals. The diseases are interconnected through complex mechanisms, resulting in a significantly increased risk of complications and mortality. “COPD alone shortens life expectancy by 5–10 years, depending on disease severity, while untreated sleep apnea reduces it by 7–10 years,” adds Prof. MUDr. Milan Sova, Ph.D., Head of the Department of Pulmonary Diseases and Tuberculosis, Brno University Hospital.

Difficult Diagnosis of COPD–OSA Overlap

“In the Czech Republic, both COPD and OSA are severely underdiagnosed. We estimate around 300,000 COPD patients and about 8% of the population with OSA—these are huge numbers. A large portion of these patients likely have an overlap,” explains Prof. Sova. He emphasizes the need to consider this overlap in clinical practice and refer patients with suspected cases to specialized centers. “We can diagnose this condition in ventilation centers and within pulmonary clinics, but unfortunately, their capacity is limited,” he adds.

Regarding the availability of sleep-disorder diagnostic centers, Prof. Sova points to “gaps across the country.” Compared with the infrastructure supporting the national lung cancer screening program launched in January 2022, the disparity in coverage is striking.

That screening initiative involved 43 accredited centers (including half of all Czech general practitioners and 99% of outpatient pulmonologists), reaching one in nine heavy smokers (48,000 people). In contrast, centers dedicated to diagnosing sleep-related breathing disorders are found only in major university and regional hospitals.

Editorial Team, Medscope.pro

Source:

Day for Healthy Lungs –⁠ World COPD Day. Press Conference. Prague, November 11, 2025.