Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.

Abstract

Fifty patients with chronic obstructive lung disease were questioned about their sleep quality and their responses were compared with those of 40 similarly aged patients without symptomatic lung disease. Patients with chronic obstructive lung disease reported more difficulty in getting to sleep and staying asleep and more daytime sleepiness than the control group. More than twice as many patients (28%) as controls (10%) reported regular use of hypnotics. In a subgroup of 16 patients with chronic obstructive lung disease (mean FEV, 0-88 (SD 0 44) 1) sleep, breathing, and oxygenation were measured to examine the relationship between night time hypoxaemia and sleep quality. Sleep architecture was disturbed in most patients, arousals occurring from three to 46 times an hour (mean 15 (SD 14)/h). Arterial hypoxaemia during sleep was common and frequently severe. The mean (SD) arterial oxygen saturation (Sao2) at the onset of sleep was 91% (7%). Nine patients spent at least 40% of cumulative sleeping time at an Sao2 of less than 90% and six of these patients spent 90% of sleeping time below this level. Only four of 15 patients did not develop arterial desaturation during sleep. The mean minimum Sao2 during episodes of desaturation was less in rapid eye movement (REM) sleep (72% (17%)) than in non-REM sleep (78% (10%); p < 0 05). The predominant breathing abnormality associated with desaturation was hypoventilation; only one patient had obstructive sleep apnoea. Arousals were related to oxygenation during sleep such that the poorer a patient's arterial oxygenation throughout the night the more disturbed his sleep (arousals/h v Sao2 at or below which 40% of the total sleep time was spent: r = 0-71, p < 0X01). Hypoxaemia during sleep was related to waking values of Sao2 and PaCo2 but not to other daytime measures of lung function.It is well recognised that sleep is associated with arterial oxygen desaturation in patients with chronic obstructive lung disease.' -6 Some physiological consequences of this desaturation, such as pulmonary hypertension, have been well investigated2 7 -9; reports of the consequences of arterial hypoxaemia in terms of quality of sleep and sleep related symptoms, however, are few and conflicting.'0'-4

Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease

“…The scarce literature published on daytime sleepiness in patients with COPD is conflicting. Cormick et al (35) evaluated sleep quality and daytime sleepiness in fifty patients with COPD and reported difficulty in getting to sleep and staying asleep and daytime sleepiness compared with age-matched controls without symptomatic lung disease. Interestingly, more than twice as many patients (28%) as controls (10%) reported regular use of hypnotics.…”

Supplemental Oxygen Needs During Sleep. Who Benefits?

“…94 In patients with severe COPD, poor sleep quality is often reported. 37,[52][53][54] However, in those with more mild respiratory disease studied in the Sleep Heart Health Study, there were only very minor effects of COPD on sleep quality and architecture. 64 Thus, sleep complaints or classic symptoms of OSA in these patients should be evaluated with PSG, although this approach may underestimate the number of affected patients, since some OSA may be minimally symptomatic but still clinically relevant.…”

“…36 Some studies have also reported that arousals from sleep may be related to episodes of desaturation, and in this way NOD may lead to sleep fragmentation. 37 Importantly, NOD causes surges in both systemic and pulmonary blood pressure, which has been of interest when exploring links between OSA and pulmonary and systemic hypertension. 24 In OSA patients without intrinsic lung disease, repetitive, transient oxygen desaturation can lead to (generally mild) pulmonary hypertension.…”

Respiratory medications and sleep

“…In patients with chronic obstruction pulmonary disease (COPD), this sleep-related hypoventilation can result in clinically significant nocturnal hypoxemia and hypercapnia [12,13]. Patients with COPD also frequently report poor sleep, including increased sleep latency and nocturnal awakenings [14].…”