Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors

O’Donoghue, Fergal J; Catcheside, Peter; Ellis, E E; Grunstein, R; Pierce, Robert J; Rowland, Lesley; Collins, E R; Rochford, S. E.; McEvoy, R. Doug

doi:10.1183/09031936.03.00066802

Cited by 113 publications

(79 citation statements)

References 37 publications

(49 reference statements)

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“…In one study of 54 stable hypercapnic COPD patients without concomitant sleep apnea or morbid obesity, 43% were found to have sleep hypoventilation. 97 BMI, baseline PaCO 2 , and time spent in REM sleep were the strongest predictors of the severity of sleep hypoventilation. In contrast, another study of 23 COPD patients, most of whom did not have daytime hypercapnia, showed a mean increase in transcutaneous PCO 2 during sleep of only 6 mmHg, similar to that in controls.…”

Section: Sleep Hypoventilation Epidemiologymentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

151

125

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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Section: Sleep Hypoventilation Epidemiologymentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

151

125

View full text Add to dashboard Cite

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“…We corrected the P tcCO 2 values by subtracting the baseline offset alone, and then by subtracting both the baseline offset and the drift over the 8 hours. 10 A spreadsheet example of the correction process is available in the supplementary materials at http://www.rcjournal.com.…”

Section: Methods For Correcting Electrode Drift and Offsetmentioning

confidence: 99%

“…To assess the validity of this procedure we also assessed the utility of the previously published methods for correction of offset and electrode drift in P tcCO 2 values. 10 …”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Measurement of Carbon Dioxide Tension During Extended Monitoring: Evaluation of Accuracy and Stability, and an Algorithm for Correcting Calibration Drift

et al. 2011

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BACKGROUND: When polysomnography is indicated in a patient with a presumed sleep disorder, continuous monitoring of arterial carbon dioxide tension (P aCO 2 ) is desirable, especially if nocturnal hypoventilation is suspected. Transcutaneous CO 2 monitors (P tcCO 2 ) provide a noninvasive correlate of P aCO 2 , but their accuracy and stability over extended monitoring have been considered inadequate for the diagnosis of hypoventilation. We examined the stability and accuracy of P tcCO 2 measurements and the performance of a previously described linear interpolation technique designed to correct for calibration drift. METHODS: We compared the P tcCO 2 values from 2 TINA TCM-3 monitors to P aCO 2 values from arterial blood samples obtained at the beginning, every 15 min of the first hour, and then hourly over 8 hours of monitoring in 6 hemodynamically stable, male, intensive care patients (mean age 46 ؎ 17 y). RESULTS: Time had a significant (P ‫؍‬ .002) linear effect on the P tcCO 2 -P aCO 2 difference, suggesting calibration drift over the monitoring period. We found no differences between monitor type or interaction between time and monitor type. For the 2 monitors the uncorrected bias was 3.6 mm Hg and the limits of agreement were ؊5.1 to 12.3 mm Hg. Our linear interpolation algorithm improved the bias and limits of agreement to 0.4 and ؊5.5 to 6.4 mm Hg, respectively. CONCLUSIONS: Following stabilization and correction for both offset and drift, P tcCO 2 tracks P aCO 2 with minimal residual bias over 8 hours of monitoring. Should future research confirm these findings, then interpolated P tcCO 2 may have an increased role in detecting sleep hypoventilation and assessing the efficacy of treatment.

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“…In patients with chronic obstruction pulmonary disease (COPD), this sleep-related hypoventilation can result in clinically significant nocturnal hypoxemia and hypercapnia [12,13]. Patients with COPD also frequently report poor sleep, including increased sleep latency and nocturnal awakenings [14].…”

Section: Copdmentioning

confidence: 99%

Respiratory medications and sleep

Bercovitch

Tsai

2012

Curr Respir Care Rep

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Respiratory physiology is affected by sleep. Patients with chronic lung disease often complain of poor sleep quality. Sleep disturbances may result from poor control of underlying lung disease, thereby disrupting sleep. Sleep disruption may result from hypoventilation resulting in worsened gas exchange. Sleep quality may also be affected by the respiratory medications used to treat certain lung diseases. These medications can have positive effects on sleep by providing better control of underlying respiratory abnormalities and therefore offering better sleep quality. These medications may also have undesirable side effects which can worsen sleep, such as hyperarousal resulting from corticosteroid use. Knowledge of medication effects on sleep is important in management of patients with underlying lung disease. As with all medications, it is important to balance potential benefits with possible negative side effects. This article discusses the effects of common medications used to treat respiratory diseases and their impact on sleep.

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Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors

Cited by 113 publications

References 37 publications

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Transcutaneous Measurement of Carbon Dioxide Tension During Extended Monitoring: Evaluation of Accuracy and Stability, and an Algorithm for Correcting Calibration Drift

Respiratory medications and sleep

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