Persistent Hypoxemia and Excessive Daytime Sleepiness in Chronic Obstructive Pulmonary Disease (COPD)

Orr, William C.; Shamma-Othman, Zeina; Levin, David C.; Othman, Joe; Rundell, O. H.

doi:10.1378/chest.97.3.583

Cited by 30 publications

(16 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there was a trend for an inverse relationship between sleep latency (MSLT) and awake Pa,O 2 , this did not reach statistical significance (r=-0.47, p=0.09), which may have been partly due to the small patient population. These findings are consistent with those in patients with COPD, where daytime sleepiness has not been found to be related to hypoxaemia [21], but, nevertheless, indicate that nocturnal hypoxaemia promotes sleep loss, reflected by reduced sleep efficiency ( fig. 1).…”

Section: Pathogenesis Of Impaired Daytime Functionsupporting

confidence: 90%

Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease

Dancey¹,

Tullis²,

Heslegrave³

et al. 2002

Eur Respir J

View full text Add to dashboard Cite

It was hypothesized that adult cystic fibrosis (CF) patients with severe lung disease have impaired daytime function related to nocturnal hypoxaemia and sleep disruption.Nineteen CF patients (forced expiratory volume in one second 28¡7% predicted) and 10 healthy subjects completed sleep diaries, overnight polysomnography (PSG), and assessment of daytime sleepiness and neurocognitive function.CF patients tended to report more awakenings (0.7 ¡ 0.5 versus 0.3 ¡ 0.2?h -1 , p=0.08), and PSG revealed reduced sleep efficiency (71 ¡ 25 versus 93 ¡ 4%, p=0.004) and a higher frequency of awakenings (4.2 ¡ 2.7 versus 2.4 ¡ 1.4?h -1 , p=0.06). Mean arterial oxygen saturation during sleep was lower in CF patients (84.4 ¡ 6.8 versus 94.3 ¡ 1.5%, pv0.0001) and was associated with reduced sleep efficiency (regression coefficient (r)=0.57, p=0.014). CF patients had short sleep latency on the multiple sleep latency test (6.7¡3 min). The CF group reported lower levels of activation and happiness and greater levels of fatigue (pv0.01), which correlated with indices of sleep loss, such as sleep efficiency (r=0.47, p=0.05). Objective neurocognitive performance was also impaired in CF patients, reflected by lower throughput for simple addition/subtraction, serial reaction and colour-word conflict.The authors concluded that adult cystic fibrosis patients with severe lung disease have impaired neurocognitive function and daytime sleepiness, which is partly related to chronic sleep loss and nocturnal hypoxaemia.

show abstract

Section: Pathogenesis Of Impaired Daytime Functionsupporting

confidence: 90%

Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease

Dancey¹,

Tullis²,

Heslegrave³

et al. 2002

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Despite subjective and objective findings of poor sleep quality in emphysema, Orr and coworkers (36) noted no evidence of daytime sleepiness, as measured with a multiple sleep latency test (mean sleep latency, 11 6 4 min), in 14 patients with severe COPD. However, the study involved only a small number of patients, and none of the patients had any subjective complaints of daytime sleepiness.…”

Section: Consequences Of Poor Sleep Quality In Emphysemamentioning

confidence: 97%

“…These findings apply to both general and disease-specific quality of life measures. However, few studies have examined the extent to which disturbed sleep contributes to these low quality of life scores (3,36). Indicators of poor sleep quality include the subjective complaints of difficulty falling and staying asleep, morning tiredness, early awakenings, and excessive daytime sleepiness (3, 9-11).…”

Section: Sleep Quality In Emphysema Prevalence and Characteristicsmentioning

confidence: 99%

Sleep Abnormalities and Treatment in Emphysema

Krachman

Minai

Scharf

2008

Proceedings of the American Thoracic Society

View full text Add to dashboard Cite

Sleep abnormalities are common in severe emphysema, and include poor sleep quality, the development of nocturnal oxygen desaturation, and the presence of coexistent obstructive sleep apnea. With lower baseline oxygenation and abnormal respiratory mechanics in patients with severe emphysema, alterations in ventilatory control and respiratory muscle function that normally occur during sleep can have profound effects, and contribute to the development of sleep abnormalities. The impact on quality of life, cardiopulmonary hemodynamics, and overall survival remains uncertain. In addition, treatment for chronic obstructive pulmonary disease and its effect on sleep abnormalities have demonstrated conflicting results. More recently, as part of the National Emphysema Treatment Trial, lung volume reduction surgery has been shown to improve both sleep quality and nocturnal oxygenation in emphysema. Although indications for performing an overnight polysomnogram in patients with emphysema have been debated, recommendations have been presented. Future studies investigating disease mechanism and response to therapy in patients with sleep abnormalities and severe emphysema are warranted.Keywords: emphysema; sleep; hypoventilation; apnea; oxygenation Patients with severe emphysema commonly have distinct abnormalities related to sleep that include poor sleep quality (1-4) and the development of nocturnal oxygen desaturation (NOD) (1,(3)(4)(5)(6)(7)(8). Patients with emphysema often complain of difficulty with initiating and maintaining sleep (3), and objective measurements have demonstrated increased sleep latency, decreased total sleep time, and an increased number of nocturnal arousals (1-4). These findings contribute to the excessive daytime sleepiness and early morning awakenings reported in these patients (9-11). As part of the National Emphysema Treatment Trial (NETT), sleep quality and nocturnal oxygenation have been examined in patients with severe emphysema who were being evaluated for lung volume reduction surgery (LVRS) (4, 12).Episodes of NOD are more pronounced during REM sleep (2, 5-7), and can develop despite an awake Pa O 2 . 60 mm Hg. Although predictors for the development of NOD have been identified (3,7,8,(13)(14)(15)(16)(17)(18), its effect on pulmonary hemodynamics and overall survival are still uncertain. In addition, patients with emphysema with coexistent obstructive sleep apnea (OSA), often referred to as the ''overlap syndrome,'' also demonstrate NOD. This review examines the physiological variables that affect sleep quality and nocturnal oxygenation in severe emphysema. In addition, therapeutic interventions, including LVRS, and their impact on sleep quality and overall survival are reviewed. Finally, limitations in the current literature and open questions that remain to be answered are discussed. PHYSIOLOGICAL ALTERATIONS DURING SLEEPVentilation is normally controlled by a combination of two systems: a metabolic system responsible for the automatic changes directly related to gas exchange, and a beha...

show abstract

“…For instance, Saaresranta et al [16] measured nighttime sleep in women with COPD to evaluate daytime sleepiness complaints and reported a mean TST of 281 min. In like manner, Orr et al [17] reported a mean TST of 258 min in men with COPD and hypoxemia.…”

Section: Discussionmentioning

confidence: 86%

The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease

et al. 2008

View full text Add to dashboard Cite

show abstract

Persistent Hypoxemia and Excessive Daytime Sleepiness in Chronic Obstructive Pulmonary Disease (COPD)

Cited by 30 publications

References 6 publications

Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease

Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease

Sleep Abnormalities and Treatment in Emphysema

The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease

Contact Info

Product

Resources

About