The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis

Abstract Purpose 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 under...

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Main Authors: Staci L. Orbell, Jonna L. Morris, Paul W. Scott, Lynn M. Baniak, Christopher C. Imes, Bomin Jeon, Weiwen Wang, Yue Dong, Patrick J. Strollo, Faith S. Luyster
Format: Article
Language:English
Published: BMC 2025-06-01
Series:BMC Pulmonary Medicine
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Online Access:https://doi.org/10.1186/s12890-025-03752-4
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author Staci L. Orbell
Jonna L. Morris
Paul W. Scott
Lynn M. Baniak
Christopher C. Imes
Bomin Jeon
Weiwen Wang
Yue Dong
Patrick J. Strollo
Faith S. Luyster
author_facet Staci L. Orbell
Jonna L. Morris
Paul W. Scott
Lynn M. Baniak
Christopher C. Imes
Bomin Jeon
Weiwen Wang
Yue Dong
Patrick J. Strollo
Faith S. Luyster
author_sort Staci L. Orbell
collection DOAJ
description Abstract Purpose 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. Methods 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 ≥ 40.0 kg/m2. Results 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, 58.758–58.794%]; ) 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. Conclusion 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. Trial registration : Not applicable.
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spelling doaj-art-1a7adeff3d2a4a8a983113d33dea00642025-08-20T03:10:38ZengBMCBMC Pulmonary Medicine1471-24662025-06-012511810.1186/s12890-025-03752-4The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysisStaci L. Orbell0Jonna L. Morris1Paul W. Scott2Lynn M. Baniak3Christopher C. Imes4Bomin Jeon5Weiwen Wang6Yue Dong7Patrick J. Strollo8Faith S. Luyster9Veterans Affairs Pittsburgh Healthcare SystemSchool of Nursing, University of PittsburghSchool of Nursing, University of PittsburghVeterans Affairs Pittsburgh Healthcare SystemSchool of Nursing, University of PittsburghCollege of Nursing and Research Institute of Nursing Science, Seoul National UniversitySchool of Nursing, University of PittsburghSchool of Nursing, University of PittsburghVeterans Affairs Pittsburgh Healthcare SystemVeterans Affairs Pittsburgh Healthcare SystemAbstract Purpose 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. Methods 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 ≥ 40.0 kg/m2. Results 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, 58.758–58.794%]; ) 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. Conclusion 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. Trial registration : Not applicable.https://doi.org/10.1186/s12890-025-03752-4Sleep apneaObstructive; pulmonary diseaseChronic obstructive; obesityMorbid
spellingShingle Staci L. Orbell
Jonna L. Morris
Paul W. Scott
Lynn M. Baniak
Christopher C. Imes
Bomin Jeon
Weiwen Wang
Yue Dong
Patrick J. Strollo
Faith S. Luyster
The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
BMC Pulmonary Medicine
Sleep apnea
Obstructive; pulmonary disease
Chronic obstructive; obesity
Morbid
title The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
title_full The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
title_fullStr The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
title_full_unstemmed The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
title_short The triple overlap of COPD, severe obesity, and high risk of OSA: insights from an NHANES analysis
title_sort triple overlap of copd severe obesity and high risk of osa insights from an nhanes analysis
topic Sleep apnea
Obstructive; pulmonary disease
Chronic obstructive; obesity
Morbid
url https://doi.org/10.1186/s12890-025-03752-4
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