Oxygen Desaturation During Sleep as a Determinant of the “Blue and Bloated” Syndrome

DeMarco, Frank J.; Wynne, James W.; Block, A. Jay; Boysen, Philip G.; Taasan, Vicente

doi:10.1378/chest.79.6.621

Cited by 81 publications

(29 citation statements)

References 16 publications

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“…Several studies have found that patients with hypercapnia whilst awake are more likely to exhibit nocturnal oxygen desaturation [11,13,14,[24][25][26]28], but most of these studies have indicated that daytime Pa,CO 2 was not, in fact, an independent predictor of Sa,O 2 during sleep [13,14,24,25]. We found that Pa,CO 2 whilst awake was an independent predictor of nocturnal Sa,O 2 .…”

Section: Prediction Of Nocturnal Desaturationmentioning

confidence: 58%

Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia

Chaouat¹,

Weitzenblum²,

Kessler³

et al. 1997

Eur Respir J

155

102

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It has been hypothesized but not firmly established that sleep-related hypoxaemia could favour the development of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) patients without marked daytime hypoxaemia.We have investigated the relationships between pulmonary function data, sleeprelated desaturation and daytime pulmonary haemodynamics in a group of 94 COPD patients not qualifying for conventional O 2 therapy (daytime arterial oxygen tension (Pa,O 2 ) in the range 7.4-9.2 kPa (56-69 mmHg)). Nocturnal desaturation was defined by spending ≥30% of the recording time with a transcutaneous O 2 saturation <90%. An obstructive sleep apnoea syndrome was excluded by polysomnography.Sixty six patients were desaturators (Group 1) and 28 were nondesaturators (Group 2). There was no significant difference between Groups 1 and 2 with regard to pulmonary volumes and Pa,O 2 (8.4±0.6 vs 8.4±0.4 kPa (63±4 vs 63±3 mmHg)) but arterial carbon dioxide tension (Pa,CO 2 ) was higher in Group 1 (6.0±0.7 vs 5.3±0.5 kPa (45±5 vs 40±4 mmHg); p<0.0001). Mean pulmonary artery pressure (Ppa) was very similar in the two groups (2.6±0.7 vs 2.5±0.6 kPa (19±5 vs 19±4 mmHg)). No individual variable or combination of variables could predict the presence of pulmonary hypertension.It is concluded that in these patients with chronic obstructive pulmonary disease with modest daytime hypoxaemia, functional and gasometric variables (with the noticeable exception of arterial carbon dioxide tension) cannot predict the presence of nocturnal desaturation; and that mean pulmonary artery pressure is not correlated with the degree and duration of nocturnal hypoxaemia. These results do not support the hypothesis that sleep-related hypoxaemia favours the development of pulmonary hypertension. Eur Respir J 1997; 10: 1730-1735 The worsening of hypoxaemia during sleep in patients with chronic obstructive pulmonary disease (COPD) has been documented since the early 1960s [1], and has since been confirmed by polysomnographic studies [2,3], which have included continuous monitoring of oxygen saturation from the late 1970s [4][5][6][7][8][9][10]. It must be emphasized that most of these studies have included patients with severe COPD exhibiting marked daytime hypoxaemia. Is sleep-related hypoxaemia present in patients with less severe COPD with mild or absent daytime hypoxaemia? Several studies of the literature [11][12][13] have shown that a relatively high percentage of these COPD patients exhibit significant nocturnal hypoxaemia, which naturally raises the question: Does this hypoxaemia, limited to sleep, deserve treatment with nocturnal oxygen? Such a treatment could be justified if nocturnal hypoxaemia had deleterious effects on life expectancy, which is rather controversial [14,15], and on pulmonary haemodynamics. It has been hypothesized [16,17] that isolated nocturnal hypoxaemia, occurring in patients without significant daytime hypoxaemia, could lead to permanent (daytime) pulmonary hypertension, but this hypothesis has not, so...

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Section: Prediction Of Nocturnal Desaturationmentioning

confidence: 58%

Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia

Chaouat¹,

Weitzenblum²,

Kessler³

et al. 1997

Eur Respir J

155

102

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“…More profound arterial hypoxemia (and perhaps associated hypercapnia) are found in patients with COPD-OSA than those with OSA alone (46,47). In addition, changes during sleep in chemoreceptor sensitivity and ventilatory control, respiratory mechanics, respiratory muscle function, and symptoms such as cough and sputum production may occur in these patients (48)(49)(50)(51)(52)(53)(54)(55)(56). Patients with severe emphysema are known to have poor sleep quality.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe COPD

Soler¹,

Gaio²,

Powell³

et al. 2015

Annals ATS

141

116

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Rationale: When obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) coexist in the so-called "overlap" syndrome, a high risk for mortality and morbidity has been reported. There is controversy about the prevalence of OSA in people affected by COPD.Objectives: The purpose of this study was to investigate objective meaures of sleep-disordered breathing in patients with moderate to severe COPD to test the hypothesis that COPD is associated with an increased prevalence of OSA.Methods: Fifty-four patients (54% men) with moderate to severe COPD were enrolled prospectively (mean 6 SD, FEV 1 = 42.8 6 19.8% predicted, and FEV 1 /FVC = 42.3 6 13.1). Twenty patients (37%) were on supplemental oxygen at baseline. Exercise tolerance; questionnaires related to symptoms, sleep, and quality of life; and home polysomnography were obtained.Measurements and Main Results: Forty-four patients had full polysomnography suitable for analysis. OSA (apnea-hypopnea index . 5/h) was present in 29 subjects (65.9%). Sleep efficiency was poor in 45% of subjects.Conclusions: OSA is highly prevalent in patients with moderate to severe COPD referred to pulmonary rehabilitation. Sleep quality is also poor among this selected group. These patients have greaterthan-expected sleep-disordered breathing, which could be an important contributory factor to morbidity and mortality. Pulmonary rehabilitation programs should consider including a sleep assessment in patients with moderate to severe COPD and interventions when indicated to help reduce the impact of OSA in COPD.

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“…Im Vergleich zu Patienten vom Typ ¹Pink Puffer" sind ¹Blue Bloater" weitaus stärker betroffen: Ihre Zwerchfellfunktion ist gestört, und die Sauerstoffsättigung kann während der Nacht um bis zu 30 % abfallen [27]. Eine Ver− schlechterung der Oxygenierung im Schlaf kommt bei einer FEV 1 unter 60 % des Solls zwar häufiger vor [28], eine verlässliche Vorhersage der nächtlichen Gasaustauschstörung anhand von Lungenfunktionsparametern oder der Sauerstoffsättigung im Wachzustand ist jedoch nicht möglich.…”

Section: Copd Und Schlafunclassified

“…Komorbiditäten wie die obstruktive Schlafapnoe (OSA) haben ei− nen entscheidenden Einfluss auf das Ausmaß der nächtlichen Gasaustauschstörung, und sie liefern eine plausible Interpretati− on für die Unterschiede zwischen ¹Pink Puffern" und ¹Blue Bloa− tern" [27]. Von den OSA−Betroffenen haben 9 ± 16 % gleichzeitig eine COPD, und umgekehrt findet man bei 6 ± 14 % der COPD−Pa− tienten gleichzeitig eine OSA.…”

Section: Copd Und Schlafunclassified

Beurteilungs- und Prognosekriterien bei COPD

Dierkesmann¹,

Gillissen²,

Lorenz³

et al. 2009

Pneumologie

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Oxygen Desaturation During Sleep as a Determinant of the “Blue and Bloated” Syndrome

Cited by 81 publications

References 16 publications

Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia

Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia

High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe COPD

Beurteilungs- und Prognosekriterien bei COPD

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