Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea

Abstract

BackgroundExercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea.MethodsForty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment.ResultsAfter two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564).ConclusionNocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome.Trial registrationNCT00914264

Effect of Yoga Practice on Levels of Inflammatory Markers After Moderate and Strenuous Exercise

“…The standardized 10 m Shuttle Walk test was the exercise protocol adopted for this study [11,12]. In the 10m Shuttle Walk test, marker cones are positioned at the two ends of a plain 10m long path.…”

Chronic obstructive pulmonary disease comorbidities

“…Less is known about the mechanisms of this comorbid association, with emerging data linking sleep apnea with higher inflammatory markers in COPD study participants with sleep apnea [38]. The message for the practitioner is clear: it is important to search for sleep apnea among patients with or at risk for COPD, especially because sleep apnea treatment in this population is associated, in observational studies, with better outcomes, including mortality and functional status [39,40].…”

Obstructive sleep apnea exacerbates airway inflammation in patients with chronic obstructive pulmonary disease

“…Moreover, TNFα can activate transcription factor nuclear factor-κ-B, which is up-regulated in macrophages and epithelial cells [37]. that the overlap syndrome is associated with an increased risk of death and hospitalization because of exacerbation, and that CPAP treatment could improve survival, decrease hospitalizations [6,[40][41][42], and improve walking capacity [43]. Several potential mechanisms that may account for the observed higher mortality in overlap patients have been reviewed previously [44].…”