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Patients with\n COPD<\/jats:styled-content>\n and\n OSA<\/jats:styled-content>\n may have fewer obstructive events, but underlying mechanisms remain unclear. Using a large clinical cohort, we tested the hypothesis that\n OSA<\/jats:styled-content>\n severity and pathophysiological traits differ in\n OVS<\/jats:styled-content>\n versus\n OSA<\/jats:styled-content>\n \u2010alone. Data from the\n SNOOzzzE<\/jats:styled-content>\n cohort (3319 adults with in\u2010laboratory polysomnography 2017\u20132019) were used.\n OVS<\/jats:styled-content>\n patients were identified through chart review and matched to\n OSA<\/jats:styled-content>\n \u2010only patients (3:1) by age, sex, and body mass index.\n OSA<\/jats:styled-content>\n severity was assessed using apnea hypopnea index (\n AHI<\/jats:styled-content>\n ), hypoxic burden (\n HB<\/jats:styled-content>\n ), and\n T90<\/jats:styled-content>\n (%time with\n \n SpO\n 2<\/jats:sub>\n <\/jats:styled-content>\n \u2009<\u200990%), while\n OSA<\/jats:styled-content>\n traits were quantified from polysomnographic signals via validated algorithms. Mixed model analysis quantified group differences before and after adjustment for covariate differences (Black race, smoking) accounting for matching as a random effect. In our diverse cohort (103\n OVS<\/jats:styled-content>\n vs. 309 OSA\u2010only; 38% women, 44% non\u2010White, 17% Hispanic),\n OVS<\/jats:styled-content>\n patients tended to have a lower\n AHI<\/jats:styled-content>\n and\n HB<\/jats:styled-content>\n (approximately \u221210%,\n p<\/jats:italic>\n \u2009<\u20090.1), but significantly higher\n T90<\/jats:styled-content>\n (~50%,\n p<\/jats:italic>\n \u2009=\u20090.003).\n OVS<\/jats:styled-content>\n patients had less upper airway collapsibility, lower arousal threshold, lower ventilatory response to arousal (\n p<\/jats:italic>\n \u2009<\u20090.05) and tended to have higher upper airway dilator muscle compensation (\n p<\/jats:italic>\n \u2009=\u20090.09). In adjusted analyses, effect estimates were similar, but significance was attenuated. Hyperinflation and air trapping were inversely associated with\n AHI<\/jats:styled-content>\n \/\n HB<\/jats:styled-content>\n .\n OSA<\/jats:styled-content>\n severity and mechanisms differ in\n OVS<\/jats:styled-content>\n versus\n OSA<\/jats:styled-content>\n \u2010only. Future research should seek to evaluate these differences for their prognostic ability.\n <\/jats:p>","DOI":"10.14814\/phy2.70438","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T01:54:08Z","timestamp":1751594048000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Obstructive sleep apnea severity and pathophysiological traits in overlap syndrome: Insights from the\n SNOOzzzE<\/scp>\n cohort"],"prefix":"10.14814","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-2586","authenticated-orcid":false,"given":"Janna","family":"Raphelson","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Sanchez\u2010Azofra","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"},{"name":"Division of Pulmonary and Sleep Medicine Hospital Universitario de la Princesa, Universidad Aut\u00f3noma de Madrid Madrid Spain"},{"name":"Apnimed Inc. Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy E.","family":"Orr","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Parra","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"McGinnis","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Salinas","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Luu","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Sands","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Azarbarzin","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Owens","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Marin","sequence":"additional","affiliation":[{"name":"Hospital Universitario Miguel Servet, IIS Arag\u00f3n\u2010CIBERES and Department of Medicine University of Zaragoza Zaragoza Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep Medicine and Physiology University of California, San Diego (UCSD) San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher 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