Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono

Mueller, P; Gomes, Marcílio Delmondes; Viegas, Carlos Alberto de Assis; Neder, J. Alberto

doi:10.1590/s1806-37132008000800005

Cited by 14 publications

(10 citation statements)

References 27 publications

(33 reference statements)

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“…Other studies have used pulse oximetry rather than polysomnography to diagnose nocturnal hypoxemia in small samples and found prevalence rates ranging from 47% to 52%. 10 , 11 , 13 In contrast, authors using methodologies similar to that of the present study have found similar prevalence rates. 7 , 12 …”

Section: Discussionsupporting

confidence: 67%

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

et al. 2017

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Objective:To infer the prevalence and variables predictive of isolated nocturnal hypoxemia and obstructive sleep apnea (OSA) in patients with COPD and mild hypoxemia.Methods:This was a cross-sectional study involving clinically stable COPD outpatients with mild hypoxemia (oxygen saturation = 90-94%) at a clinical center specializing in respiratory diseases, located in the city of Goiânia, Brazil. The patients underwent clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, six-minute walk test assessment, and chest X-ray.Results:The sample included 64 patients with COPD and mild hypoxemia; 39 (61%) were diagnosed with sleep-disordered breathing (OSA, in 14; and isolated nocturnal hypoxemia, in 25). Correlation analysis showed that PaO2 correlated moderately with mean sleep oxygen saturation (r = 0.45; p = 0.0002), mean rapid eye movement (REM) sleep oxygen saturation (r = 0.43; p = 0.001), and mean non-REM sleep oxygen saturation (r = 0.42; p = 0.001). A cut-off point of PaO2 ≤ 70 mmHg in the arterial blood gas analysis was significantly associated with sleep-disordered breathing (OR = 4.59; 95% CI: 1.54-13.67; p = 0.01). The model showed that, for identifying sleep-disordered breathing, the cut-off point had a specificity of 73.9% (95% CI: 51.6-89.8%), a sensitivity of 63.4% (95% CI: 46.9-77.9%), a positive predictive value of 81.3% (95% CI: 67.7-90.0%), and a negative predictive value of 53.1% (95% CI: 41.4-64.4%), with an area under the ROC curve of 0.69 (95% CI: 0.57-0.80), correctly classifying the observations in 67.2% of the cases. Conclusions:In our sample of patients with COPD and mild hypoxemia, the prevalence of sleep-disordered breathing was high (61%), suggesting that such patients would benefit from sleep studies.

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Section: Discussionsupporting

confidence: 67%

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

et al. 2017

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“…In a study focused on the systemic effects of nocturnal hypoxemia in COPD patients, the number of patients presenting C reactive protein (CRP) levels above those considered normal was significantly greater in the desaturation group which is the evidence of pronounced inflammatory activation in COPD patients with nocturnal hypoxemia. [16] …”

Section: Discussionmentioning

confidence: 99%

“…Because of a number of factors, mainly including: alveolar hypoventilation, airway obstruction, hyperinflation, respiratory muscle dysfunction, blunted ventilatory responses to hypoxia and ventilation-perfusion mismatch, emphysematous patients run a high risk of developing SH [8]–[10]. Compared to their non-SH brethren, emphysematous patients with SH have greater degrees of pulmonary hypertension and cor pulmonale [11], require more frequent hospitalizations, sustain higher mortality rates [12]–[15] and demonstrate systemic evidence of pronounced inflammatory activation [16] which may cause inflammatory damages to the liver as well.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Sleep Hypoxia on Coagulant Factors and Hepatic Inflammation in Emphysematous Rats

et al. 2010

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ObjectivesTo develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether SHE results in more severe hepatic inflammation than emphysema alone and whether the inflammation changes levels of coagulant/anticoagulant factors synthesized in the liver.MethodsSeventy-five rats were put into 5 groups: SH control (SHCtrl), treated with sham smoke exposure (16 weeks) and SH exposure (12.5% O2, 3 h/d, latter 8 weeks); emphysema control (ECtrl), smoke exposure and sham SH exposure (21% O2); short SHE (SHEShort), smoke exposure and short SH exposure (1.5 h/d); mild SHE (SHEMild), smoke exposure and mild SH exposure (15% O2); standard SHE (SHEStand), smoke exposure and SH exposure. Therefore, ECtrl, SHEShort, SHEMild and SHEStand group were among emphysematous groups. Arterial blood gas (ABG) data was obtained during preliminary tests. After exposure, hepatic inflammation (interleukin -6 [IL-6] mRNA and protein, tumor necrosis factor α [TNFα] mRNA and protein) and liver coagulant/anticoagulant factors (antithrombin [AT], fibrinogen [FIB] and Factor VIII [F VIII]) were evaluated. SPSS 11.5 software was used for statistical analysis.ResultsCharacteristics of emphysema were obvious in emphysematous groups and ABGs reached SH criteria on hypoxia exposure. Hepatic inflammation parameters and coagulant factors are the lowest in SHCtrl and the highest in SHEStand while AT is the highest in SHCtrl and the lowest in SHEStand. Inflammatory cytokines of liver correlate well with coagulant factors positively and with AT negatively.ConclusionsWhen SH is combined with emphysema, hepatic inflammation and coagulability enhance each other synergistically and produce a more significant liver-derivative inflammatory and prothrombotic status.

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“…In fact, these patients frequently presented periods of hypoxia, especially when exercising, 9 , 10 during activities of daily living 11 and sleep. 12 , 13 Although the use of the expression “chronic hypoxia” is accepted in chronic obstructive pulmonary disease (COPD) for instance, its timely measurement during evaluation can yield results which fall between normal limits. The expression will be used in a consistent way throughout this manuscript.…”

Section: Pathophysiology Of Chronic Hypoxia Effects In Central Nervoumentioning

confidence: 99%

Cognition and chronic hypoxia in pulmonary diseases

Areza-Fegyveres

Kairalla

Carvalho

et al. 2010

Dement. neuropsychol.

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Lung disease with chronic hypoxia has been associated with cognitive impairment of the subcortical type.ObjectivesTo review the cognitive effects of chronic hypoxia in patients with lung disease and its pathophysiology in brain metabolism.MethodsA literature search of Pubmed data was performed. The words and expressions from the text subitems including “pathophysiology of brain hypoxia”, “neuropsychology and hypoxia”, “white matter injury and chronic hypoxia”, for instance, were key words in a search of reports spanning from 1957 to 2009. Original articles were included.ResultsAccording to national and international literature, patients with chronic obstructive pulmonary disease and sleep obstructive apnea syndrome perform worse on tests of attention, executive functions and mental speed. The severity of pulmonary disease correlates with degree of cognitive impairment. These findings support the diagnosis of subcortical type encephalopathy.ConclusionCognitive effects of clinical diseases are given limited importance in congresses and symposia about cognitive impairment and its etiology. Professionals that deal with patients presenting cognitive loss should be aware of the etiologies outlined above as a major cause or potential contributory factors, and of their implications for treatment adherence and quality of life.

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Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono

Cited by 14 publications

References 27 publications

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

Sleep-disordered breathing in patients with COPD and mild hypoxemia: prevalence and predictive variables

The Effects of Sleep Hypoxia on Coagulant Factors and Hepatic Inflammation in Emphysematous Rats

Cognition and chronic hypoxia in pulmonary diseases

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