Breathing during Sleep in Patients with Nocturnal Desaturation

Becker, Heinrich F.; Piper, Amanda J.; Flynn, W. E.; McNamara, Stephen G.; Grunstein, Ronald R.; Peter, J. H.; Ce, Sullivan

doi:10.1164/ajrccm.159.1.9803037

Cited by 217 publications

(121 citation statements)

References 26 publications

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“…Minute ventilation can drop approximately 16% during NREM sleep and 32% during REM sleep in patients with COPD. 77 During wakefulness, respiration is not only under metabolic control, but also influenced by voluntary processes such as speaking and swallowing. During sleep, chemoreceptors and ventilatory centers become the sole controllers of respiration.…”

Section: Etiologymentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

158

125

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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Section: Etiologymentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

158

125

View full text Add to dashboard Cite

show abstract

“…In fact, patients with COPD frequently experience nocturnal oxygen desaturation episodes [35]. This largely reflects the physiological impact of sleep on ventilation discussed previously, and may be aggravated by changes in tidal volume and rapid shallow breathing, since accessory breathing muscles become hypotonic during sleep [17,[36][37][38], particularly during periods of REM sleep [34]. All these changes, in combination with the blunted ventilatory responses to hypercapnia during sleep alluded to before [39], lead to changes in arterial blood gases during sleep in COPD [40], as recently modelled by MARRONE et al [34].…”

Section: Pathogenesismentioning

confidence: 99%

Night-time symptoms: a forgotten dimension of COPD

Agustí¹,

Hedner²,

Marı́n³

et al. 2011

Eur Respir Rev

206

189

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Sleep quality is often poor in patients with chronic obstructive pulmonary disease (COPD), but these night-time symptoms are frequently unnoticed by physicians and/or not reported by patients themselves. Therefore, the prevalence and clinical impact of sleep disturbances and night-time symptoms in COPD is not well understood and has not been a clinical focus to date. To address this gap, an expert panel meeting was convened in Barcelona, Spain, in March 2011 to discuss the aetiology, evolution, burden, long-term clinical consequences and optimal management of night-time symptoms in COPD. The term ''night-time symptoms'' in COPD has not been distinctly defined in an objective sense but epidemiological data suggests that the prevalence of nocturnal symptoms and symptomatic sleep disturbance may exceed 75% in patients with COPD. The panel concluded that night-time symptoms in COPD are prevalent and bothersome; that their cause(s) are multiple and include demographic factors, such as age and obesity, pharmacotherapy, disease-specific symptoms and the presence of comorbid sleep disorders, and other medical conditions; and that potential long-term consequences can include lung function changes, increased exacerbation frequency, emergence or worsening of cardiovascular disease, cognitive effects, depression, impaired quality of life and increased mortality. To date, few interventional studies have investigated them, but emerging data suggest that bronchodilator therapy can improve them if deployed appropriately. In summary, night-time symptoms in COPD warrant further clinical investigation with validated tools.

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“…Patients with chronic obstructive pulmonary disease (COPD) experience sleep-related hypoventilation (1,2). However, there is controversy as to whether this occurs due to an increase in upper airway resistance or a reduction in neural respiratory drive.…”

mentioning

confidence: 99%

Neural Respiratory Drive and Ventilation in Patients with Chronic Obstructive Pulmonary Disease during Sleep

Luo

et al. 2014

Am J Respir Crit Care Med

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Breathing during Sleep in Patients with Nocturnal Desaturation

Cited by 217 publications

References 26 publications

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Night-time symptoms: a forgotten dimension of COPD

Neural Respiratory Drive and Ventilation in Patients with Chronic Obstructive Pulmonary Disease during Sleep

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