Nocturnal oxygen saturation and sleep quality in patients with advanced chronic obstructive pulmonary disease during treatment with moderate dose CR-theophylline

Abstract

The effect of a 24-h controlled-release (CR) preparation of theophylline (Th) on nocturnal arterial oxygen saturation (SaO2) and sleep quality has been evaluated in 7 patients with advanced chronic obstructive pulmonary disease (COPD) in a double-blind cross-over experiment; median values: age 61 y; PaO2 8.0 kPa; PaCO2 5.8 kPa. During treatment with 450-900 mg Th in the evening, morning plasma drug levels ranged from 5.2-12.9 micrograms.ml-1. During Th and placebo treatment, the median evening FEV1 was 0.45 l and 0.46 l, respectively, and the morning FEV1 was 0.53 l and 0.41 l. Sleep was monitored by whole-night polysomnographic recording of oximetric SaO2, airflow, respiratory and body movements (static charge sensitive bed), eye movements and submental electromyogram. There was no significant difference between Th and placebo in sleep quality. Th treatment was associated with a marginal improvement in nocturnal oxygenation in most of the patients; the average nocturnal SaO2 ranged from 84.4%-92.8% during Th and from 82.2-90.5% during placebo treatment, respectively. Only in the morning, during the last 2 h in bed, was the slight difference in SaO2 statistically significant in favour of Th. It is concluded that a moderate dose of CR-theophylline did not alter the sleep quality or substantially improve nocturnal oxygenation in patients with advanced COPD and mild to moderate day-time hypoxaemia.

Alcohol at bedtime induces minor changes in sleep stages and blood gases in stable chronic obstructive pulmonary disease

“…2 ) are more in accordance with previous findings in COPD [ 17 ]. The hypoventilation demonstrated in the present study with only two subjects (8 %) having a mean alcohol-sleep increase in ΔP tc CO 2 > 0.5 kPa and less than half having a drop in mean SpO2 > 1 % was considerably less impressive than Easton et al’s findings and more in line with the results of Brander et al[ 17 , 23 ]. One obvious explanation is the amount of alcohol and the time of ingestion related to sleep onset, as Brander et al gave less alcohol earlier in the evening compared to Easton et al, the present study using same amount of alcohol as Brander et al, but given immediately before lights off.…”

“…Later, Easton et al gave five COPD subjects 0.78 g of alcohol/kg bodyweight immediately prior to sleep and found a mean TST decrease of 19 %, a REM-sleep percentage of TST decrease by 12 % and a mean drop in S p O 2 of about 3 % [ 17 ]. In 2007, Brander et al studied nine males with advanced COPD using 0.5 g of alcohol/kg bodyweight albeit taken earlier in the evening, they did not record PSG but found only a trivial decrease in S p O 2 (<1 %) during the first 2 h of the reported sleep [ 23 ].…”

Sleep, hypnotics and chronic obstructive pulmonary disease

“…In healthy normal individuals it disturbs sleep quality by prolonging sleep latency, increasing the arousal frequency, reducing TST and increasing the amount of stage 1 sleep. 93,94 Objective studies in patients with COPD 24,95,96 have shown that it does not worsen sleep quality in these patients, and one study 24 even found an improvement in sleep quality. It is likely that the therapeutic effect of theophylline on lung function outweighs the adverse effects on sleep.…”