{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:33:55Z","timestamp":1793165635707,"version":"4.5.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Pittsburgh, School of Nursing, Sleep and Circadian Science Research Hub"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>With the rising prevalence of severe obesity, the coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) often progresses to triple overlap syndrome, a condition with significant health implications. However, its prevalence remains poorly understood. Using population-based data from the National Health and Nutrition Examination Survey (NHANES), we examined the prevalence of triple overlap of COPD, severe obesity, and high risk for OSA (HR-OSA) and associated sociodemographic factors among US adults.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A cross-sectional analysis was performed using NHANES data between 2005 and 2008 and 2015-March 2020. COPD diagnosis was collected via self-report questionnaire. HR-OSA was determined by an adapted Multivariable Apnea Prediction index. Severe obesity was defined as a body mass index of \u2265\u200940.0\u00a0kg\/m<jats:sup>2<\/jats:sup>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>From 2005 to 2008 to 2015-March 2020, the proportion of participants with triple overlap of COPD, severe obesity, and HR-OSA increased from 0.653% (95% CI, 0.651-0.655%) to 1.560% (95% CI, 1.557-1.563%). During the same period, the increase in the age-standardized prevalence of severe obesity (from 6.298% [95% CI, 6.291-6.305%] to 8.943% [95% CI, 8.936-8.950%]) and HR-OSA (from 58.667% [95% CI, 58.646-58.688%] to 58.776% [95% CI, 58.758\u201358.794%]; ) exceeded the increase for COPD (from 9.223% [95% CI, 9.215-9.231%] to 10.213% [95% CI, 10.206-10.220%]). Women and those with low family income were more likely to have triple overlap of COPD, severe obesity, and HR- OSA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The triple overlap of COPD, severe obesity, and HR-OSA significantly increased among US adults over the past 15 years, with disparities across different sociodemographic groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>: Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12890-025-03752-4","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T12:19:57Z","timestamp":1749039597000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis"],"prefix":"10.1186","volume":"25","author":[{"given":"Staci L.","family":"Orbell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonna L.","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M.","family":"Baniak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Imes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bomin","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Strollo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith S.","family":"Luyster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"3752_CR1","unstructured":"(2024) Global initiative for chronic obstructive lung disease: 2024 report. Global Initiative for Chronic Obstructive Lung Disease, Inc."},{"key":"3752_CR2","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","volume":"7","author":"AV Benjafield","year":"2019","unstructured":"Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687\u201398. https:\/\/doi.org\/10.1016\/S2213-2600(19)30198-5.","journal-title":"Lancet Respir Med"},{"key":"3752_CR3","doi-asserted-by":"publisher","first-page":"2166","DOI":"10.1016\/j.jacc.2018.11.063","volume":"73","author":"P Carter","year":"2019","unstructured":"Carter P, Lagan J, Fortune C, et al. Association of cardiovascular disease with respiratory disease. J Am Coll Cardiol. 2019;73:2166\u201377. https:\/\/doi.org\/10.1016\/j.jacc.2018.11.063.","journal-title":"J Am Coll Cardiol"},{"key":"3752_CR4","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1164\/rccm.202105-1274OC","volume":"205","author":"W Trzepizur","year":"2022","unstructured":"Trzepizur W, Blanchard M, Ganem T, et al. Sleep apnea-specific hypoxic burden, symptom subtypes, and risk of cardiovascular events and all-cause mortality. Am J Respir Crit Care Med. 2022;205:108\u201317. https:\/\/doi.org\/10.1164\/rccm.202105-1274OC.","journal-title":"Am J Respir Crit Care Med"},{"key":"3752_CR5","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1007\/s11325-021-02540-8","volume":"26","author":"M Brennan","year":"2022","unstructured":"Brennan M, McDonnell MJ, Walsh SM, et al. Review of the prevalence, pathogenesis and management of OSA-COPD overlap. Sleep Breath. 2022;26:1551\u201360. https:\/\/doi.org\/10.1007\/s11325-021-02540-8.","journal-title":"Sleep Breath"},{"key":"3752_CR6","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.18553\/jmcp.2020.26.10.1353","volume":"26","author":"YD Hong","year":"2020","unstructured":"Hong YD, Onukwugha E, Slejko JF. The economic burden of comorbid obstructive sleep apnea among patients with chronic obstructive pulmonary disease. J Manag Care Spec Pharm. 2020;26:1353\u201362. https:\/\/doi.org\/10.18553\/jmcp.2020.26.10.1353.","journal-title":"J Manag Care Spec Pharm"},{"key":"3752_CR7","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1056\/NEJMsa1909301","volume":"381","author":"ZJ Ward","year":"2019","unstructured":"Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440\u201350. https:\/\/doi.org\/10.1056\/NEJMsa1909301.","journal-title":"N Engl J Med"},{"key":"3752_CR8","doi-asserted-by":"publisher","first-page":"E61","DOI":"10.5888\/pcd20.230005","volume":"20","author":"L Zhao","year":"2023","unstructured":"Zhao L, Park S, Ward ZJ, et al. State-specific prevalence of severe obesity among adults in the US using bias correction of self-reported body mass index. Prev Chronic Dis. 2023;20:E61. https:\/\/doi.org\/10.5888\/pcd20.230005.","journal-title":"Prev Chronic Dis"},{"key":"3752_CR9","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1093\/ije\/dyz273","volume":"49","author":"Y Wang","year":"2020","unstructured":"Wang Y, Beydoun MA, Min J, et al. Has the prevalence of overweight, obesity and central obesity levelled off in the united states?? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol. 2020;49:810\u201323. https:\/\/doi.org\/10.1093\/ije\/dyz273.","journal-title":"Int J Epidemiol"},{"key":"3752_CR10","doi-asserted-by":"crossref","unstructured":"Htun Z, Zouein E, Lastra A. (2019) Effect of obesity in baseline characteristics and severity of obstructive sleep apnea in COPD-OSA overlap patients. Am J Respir Crit Care Med 199.","DOI":"10.1164\/ajrccm-conference.2019.199.1_MeetingAbstracts.A1382"},{"key":"3752_CR11","first-page":"1","volume":"2","author":"CL Johnson","year":"2014","unstructured":"Johnson CL, Dohrmann SM, Burt VL, Mohadjer LK. National health and nutrition examination survey: sample design, 2011\u20132014. Vital Health Stat. 2014;2:1\u201333.","journal-title":"Vital Health Stat"},{"key":"3752_CR12","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1093\/sleep\/18.3.158","volume":"18","author":"G Maislin","year":"1995","unstructured":"Maislin G, Pack AI, Kribbs NB, et al. A survey screen for prediction of apnea. Sleep. 1995;18:158\u201366. https:\/\/doi.org\/10.1093\/sleep\/18.3.158.","journal-title":"Sleep"},{"key":"3752_CR13","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1097\/JCN.0000000000000868","volume":"37","author":"JK Kariuki","year":"2022","unstructured":"Kariuki JK, Yang K, Scott PW, et al. Obstructive sleep apnea risk is associated with severity of metabolic syndrome: a secondary analysis of the 2015\u20132018 National health and nutrition examination survey. J Cardiovasc Nurs. 2022;37:482\u20139. https:\/\/doi.org\/10.1097\/JCN.0000000000000868.","journal-title":"J Cardiovasc Nurs"},{"key":"3752_CR14","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/GME.0000000000000744","volume":"24","author":"AG Mirer","year":"2017","unstructured":"Mirer AG, Young T, Palta M, et al. Sleep-disordered breathing and the menopausal transition among participants in the sleep in midlife women study. Menopause N Y N. 2017;24:157\u201362. https:\/\/doi.org\/10.1097\/GME.0000000000000744.","journal-title":"Menopause N Y N"},{"key":"3752_CR15","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1007\/s11325-022-02766-0","volume":"27","author":"JL Morris","year":"2023","unstructured":"Morris JL, Orbell S, Scott PW, et al. Risk stratification by sex and menopausal status in the multivariable apnea prediction index. Sleep Breath. 2023;27:1695\u2013702. https:\/\/doi.org\/10.1007\/s11325-022-02766-0.","journal-title":"Sleep Breath"},{"key":"3752_CR16","first-page":"1","volume":"2","author":"CL Johnson","year":"2013","unstructured":"Johnson CL, Paulose-Ram R, Ogden CL, et al. National health and nutrition examination survey: analytic guidelines, 1999\u20132010. Vital Health Stat. 2013;2:1\u201324.","journal-title":"Vital Health Stat"},{"key":"3752_CR17","first-page":"1","volume":"1 190","author":"LJ Akinbami","year":"2022","unstructured":"Akinbami LJ, Chen T-C, Davy O, et al. National health and nutrition examination survey, 2017-March 2020 prepandemic file: sample design, estimation, and analytic guidelines. Vital Health Stat. 2022;1 190:1\u201336.","journal-title":"Vital Health Stat"},{"key":"3752_CR18","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.smrv.2016.02.007","volume":"32","author":"MSR Shawon","year":"2017","unstructured":"Shawon MSR, Perret JL, Senaratna CV, et al. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: A systematic review. Sleep Med Rev. 2017;32:58\u201368. https:\/\/doi.org\/10.1016\/j.smrv.2016.02.007.","journal-title":"Sleep Med Rev"},{"key":"3752_CR19","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.jsmc.2024.04.003","volume":"19","author":"BHM Nguyen","year":"2024","unstructured":"Nguyen BHM, Murphy PB, Yee BJ. Chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome: an update on the epidemiology, pathophysiology, and management. Sleep Med Clin. 2024;19:405\u201317. https:\/\/doi.org\/10.1016\/j.jsmc.2024.04.003.","journal-title":"Sleep Med Clin"},{"key":"3752_CR20","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.sleep.2024.04.038","volume":"119","author":"O Coiffier","year":"2024","unstructured":"Coiffier O, Tondo P, Joyeux-Faure M, et al. Multidimensional phenotyping to distinguish among distinct obstructive sleep apnea, chronic obstructive pulmonary disease, and overlap syndrome phenotypes. Sleep Med. 2024;119:281\u20138. https:\/\/doi.org\/10.1016\/j.sleep.2024.04.038.","journal-title":"Sleep Med"},{"key":"3752_CR21","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40519-017-0456-z","volume":"23","author":"F Spelta","year":"2018","unstructured":"Spelta F, Fratta Pasini AM, Cazzoletti L, Ferrari M. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord. 2018;23:15\u201322. https:\/\/doi.org\/10.1007\/s40519-017-0456-z.","journal-title":"Eat Weight Disord"},{"key":"3752_CR22","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1513\/AnnalsATS.202006-722OC","volume":"19","author":"N Putcha","year":"2022","unstructured":"Putcha N, Anzueto AR, Calverley PMA, et al. Mortality and exacerbation risk by body mass index in patients with COPD in TIOSPIR and UPLIFT. Ann Am Thorac Soc. 2022;19:204\u201313. https:\/\/doi.org\/10.1513\/AnnalsATS.202006-722OC.","journal-title":"Ann Am Thorac Soc"},{"key":"3752_CR23","doi-asserted-by":"publisher","first-page":"00902","DOI":"10.1183\/23120541.00902-2020","volume":"7","author":"EP Brigham","year":"2021","unstructured":"Brigham EP, Anderson JA, Brook RD, et al. Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial. ERJ Open Res. 2021;7:00902\u20132020. https:\/\/doi.org\/10.1183\/23120541.00902-2020.","journal-title":"ERJ Open Res"},{"key":"3752_CR24","doi-asserted-by":"publisher","first-page":"e013983","DOI":"10.1136\/bmjopen-2016-013983","volume":"7","author":"C Xie","year":"2017","unstructured":"Xie C, Zhu R, Tian Y, Wang K. Association of obstructive sleep Apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. 2017;7:e013983. https:\/\/doi.org\/10.1136\/bmjopen-2016-013983.","journal-title":"BMJ Open"},{"key":"3752_CR25","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/eurheartj\/ehy624","volume":"40","author":"A Azarbarzin","year":"2019","unstructured":"Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep Apnoea predicts cardiovascular disease-related mortality: the osteoporotic fractures in men study and the sleep heart health study. Eur Heart J. 2019;40:1149\u201357. https:\/\/doi.org\/10.1093\/eurheartj\/ehy624.","journal-title":"Eur Heart J"},{"key":"3752_CR26","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s13679-020-00398-7","volume":"9","author":"CV Anekwe","year":"2020","unstructured":"Anekwe CV, Jarrell AR, Townsend MJ, et al. Socioeconomics of obesity. Curr Obes Rep. 2020;9:272\u20139. https:\/\/doi.org\/10.1007\/s13679-020-00398-7.","journal-title":"Curr Obes Rep"},{"key":"3752_CR27","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1097\/gme.0b013e3181cec85d","volume":"17","author":"EW Freeman","year":"2010","unstructured":"Freeman EW, Sammel MD, Lin H, Gracia CR. Obesity and reproductive hormone levels in the transition to menopause. Menopause. 2010;17:718\u201326. https:\/\/doi.org\/10.1097\/gme.0b013e3181cec85d.","journal-title":"Menopause"},{"key":"3752_CR28","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1093\/aje\/kwp203","volume":"170","author":"RC Thurston","year":"2009","unstructured":"Thurston RC, Sowers MR, Sternfeld B, et al. Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women\u2019s health across the Nation. Am J Epidemiol. 2009;170:766\u201374. https:\/\/doi.org\/10.1093\/aje\/kwp203.","journal-title":"Am J Epidemiol"},{"key":"3752_CR29","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1513\/AnnalsATS.201905-380OC","volume":"16","author":"I Soghier","year":"2019","unstructured":"Soghier I, Bro\u017cek JL, Afshar M, et al. Noninvasive ventilation versus CPAP as initial treatment of obesity hypoventilation syndrome. Ann Am Thorac Soc. 2019;16:1295\u2013303. https:\/\/doi.org\/10.1513\/AnnalsATS.201905-380OC.","journal-title":"Ann Am Thorac Soc"},{"key":"3752_CR30","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1111\/crj.13129","volume":"14","author":"S-P Hogea","year":"2020","unstructured":"Hogea S-P, Tudorache E, Fildan AP, et al. Risk factors of chronic obstructive pulmonary disease exacerbations. Clin Respir J. 2020;14:183\u201397. https:\/\/doi.org\/10.1111\/crj.13129.","journal-title":"Clin Respir J"},{"key":"3752_CR31","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1165\/rcmb.2012-0487OC","volume":"49","author":"KL Gates","year":"2013","unstructured":"Gates KL, Howell HA, Nair A, et al. Hypercapnia impairs lung neutrophil function and increases mortality in murine pseudomonas pneumonia. Am J Respir Cell Mol Biol. 2013;49:821\u20138. https:\/\/doi.org\/10.1165\/rcmb.2012-0487OC.","journal-title":"Am J Respir Cell Mol Biol"},{"key":"3752_CR32","doi-asserted-by":"publisher","first-page":"e0145455","DOI":"10.1371\/journal.pone.0145455","volume":"10","author":"S Mantwill","year":"2015","unstructured":"Mantwill S, Monestel-Uma\u00f1a S, Schulz PJ. The relationship between health literacy and health disparities: a systematic review. PLoS ONE. 2015;10:e0145455. https:\/\/doi.org\/10.1371\/journal.pone.0145455.","journal-title":"PLoS ONE"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-025-03752-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-025-03752-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-025-03752-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T12:19:59Z","timestamp":1749039599000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-025-03752-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3752"],"URL":"https:\/\/doi.org\/10.1186\/s12890-025-03752-4","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"assertion":[{"value":"17 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The NHANES protocols were approved by the National Center for Health Statistics Research Ethics Review Board, and written informed consent was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Pittsburgh Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the views of the US Department of Veterans Affairs or the US Government.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimers"}},{"value":"PJS has received medical devices for research study from Zoll Medical; received consultant honoraria from Philips Respironics and Samsung and a speaker honorarium from Inspire Medical Systems; serves on the scientific advisory board for Eli Lilly, Restora Medical, XII Medical, Cryosa, WisperSom, Apnimed, and Lunair; is a non-executive board member of Belluscura LLC; and owns stock and\/or stock options in Restora Medical and Belluscura LLC. The remaining authors have no conflicts of interest to declare.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"282"}}