Sleep and Sleep Disorders in Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the US. Numerous studies have demonstrated that sleep disturbances are common in COPD patients, with more prominent complaints in patients with more severe disease and with increasing age. Sleep disturbances may occur due to the effects of breathing abnormalities on sleep and sleep disruption. However, other etiologies may include the medications used to treat COPD, concomitant anxiety and depression, and the presence of comorbid sleep disorders. The respiratory disturbances that occur in these patients during sleep have been evaluated by examining sleep-related oxygen desaturation, reduction in pulmonary function during sleep, and development of hypoventilation during rapid eye movement sleep. Treatment includes use of nocturnal oxygen therapy, noninvasive positive pressure ventilation, and long-acting medications. There has been little study on improving sleep quality beyond treating the respiratory disease, despite the fact that numerous studies show poor sleep quality, a high prevalence of insomnia, and tolerability of newer hypnotic agents in the setting of COPD. This article defines the scope of sleep problems in the setting of COPD, reviews the impact of sleep on ventilation, explores the role of obstructive sleep apnea in the setting of COPD, and reviews therapeutic options.

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

“…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).…”

Pulmonary Rehabilitation Improves Subjective Sleep Quality in COPD

“…9 Respiratory disturbances during sleep have been associated with sleep-related oxygen desaturation, reduction in pulmonary function, and development of hypoventilation. 39 Hypoventilation during sleep causes significant gas-exchange alteration, resulting in hypercapnia and hypoxia, 9 which in turn lead to increased sleep arousals and sleep disruption. 9 Moreover, there is a normal circadian change in airways leading to nocturnal bronchoconstriction with increased airway resistance.…”

Predicting Nocturnal Hypoventilation in Hypercapnic Chronic Obstructive Pulmonary Disease Patients Undergoing Long-Term Oxygen Therapy

“…Continuous oxygen therapy has been shown to increase survival in patients with chronic respiratory failure (CRF) [1,2] and may have a beneficial impact on hemodynamics [3][4][5] , hematologic 5 characteristics [2] , exercise capacity [6] , and mental state [7] . However, it may also cause carbon dioxide retention which can be worse during sleep due to changes in ventilation [8,9] .…”