Sleep disorders and their management in patients with COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a prevalent progressive condition that adversely affects quality of life and sleep. Patients with COPD suffer from variety of sleep disorders including insomnia, sleep disordered breathing and restless leg syndrome. The sleep disorders in COPD patients may stem from poor control of primary disease or due to side effects of pharmacotherapy. Thus, optimization of COPD therapy is the main step in treating insomnia in these patients. Further, pharmacotherapy of sleep disorders may result in respiratory depression and related complications. Therefore, clear understanding of respiratory physiology during transition from wakefulness to sleep and during various stages of sleep plays an important role in therapies that are recommended in patients with significant airway obstruction. In this publication, we review respiratory physiology as it relates to sleep and discuss sleep disorders and their management in patients with COPD.

Chronic Obstructive Pulmonary Disease and Sleep Quality

“…This desaturation predisposes to cardiac arrhythmias at night [28,30], pulmonary hypertension [28,31,32] and probably deaths during acute attacks [33]. COPD patients develop hypoxia and hypercapnia of varying degrees depending on the severity of their lung disease; hyperinflation occurs in the lungs due to air trapping and work of breathing increases [3]. Oxygen desaturation among the COPD patients is probably caused by physiologic hypoventilation that occurs during sleep precipitating a considerable decrease in the SaO 2 level of hypoxemic patients [28,34,35].…”

“…These changes which usually are not consequential in healthy people may cause problems in patients with COPD. The gas exchange which occurs during sleep in patients with COPD arises as a result of the nature of the disease [3,27]. In COPD, breathing against expiratory airflow obstruction becomes more difficult during sleep when there is reduced tidal volume, ineffective ventilation, and hypoxemia [28].…”

“…They can disrupt sleep and provoke sleeplessness irrespective of the severity of the patient's respiratory disease [3].…”

“…While the respiratory system provides the oxygen that the body needs on one part, it helps remove the carbon dioxide produced by the body's metabolic processes on the other part. Arrangement of the functions of the respiratory system basically occurs through negative feedback [3]. Ventilation is normally controlled by a combination of two systems: a metabolic system responsible for the automatic changes directly related to gas exchange, and a behavioral system responsible for the voluntary changes originating from cortical and forebrain structures [22][23].…”

“…The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases". [3] COPD severely affects the social and psychological aspects of patients' lives as well as their physical health. Due to the changes of the disease process, COPD forces patients to make changes in their lifestyles.…”