Sleep-related disorders in chronic obstructive pulmonary disease

Abstract

Sleep may have several negative consequences in patients with chronic obstructive pulmonary disease (COPD). Sleep is typically fragmented with diminished slow wave and rapid-eye-movement sleep, which likely represents an important contributing factor to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep, which result in mild hypoventilation in normal subjects, are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. The co-existence of obstructive sleep apnea and COPD is also common, principally because of the high prevalence of each disorder, and there is little convincing evidence that one disorder predisposes to the other. Nonetheless, this co-existence, termed the overlap syndrome, typically results in more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without obstructive sleep apnea.

Lung Disease and Hypertension

“…The coexistence of obstructive sleep apnea syndrome and COPD is common, and it is called overlap syndrome [30]. In patients with overlap syndrome, nocturnal oxygen desaturation is severe and the prevalence of PH is very high.…”

“…In patients with overlap syndrome, nocturnal oxygen desaturation is severe and the prevalence of PH is very high. In acute exacerbation in patients with overlap syndrome, noninvasive pressure support is known to be beneficial [30]. However, the evidence is limited to whether the pressure support therapy is effective in the chronic setting of COPD patients without obstructive sleep apnea [30].…”

Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

“…COPD patients who develop hypercapnia have a particularly poor prognosis 2–4. The pathophysiological processes underlying chronic hypercapnic respiratory insufficiency in COPD are not completely understood, but proposed mechanisms include increasing respiratory muscle insufficiency,5,6 increased dead volume ventilation7 and, in particular, changes in respiratory regulation during sleep 8. Compared with individuals with healthy lungs, COPD patients are more susceptible to hypoventilation during sleep; the extent of hypoventilation during sleep depends on the extent of pulmonary function impairment9 and occurs particularly during rapid eye movement (REM) sleep.…”

Sleep quality and quality of life in patients with moderate to very severe chronic obstructive pulmonary disease

“…In the literature, it has been reported that sleep‐related symptoms in COPD may be related with significant changes in respiratory center, airway resistance and muscle contractility during sleep . These changes result in decreased sleep efficiency, prolonged time to fall asleep, reduction in total sleep time and increase in waking frequency, all leading to daytime sleepiness and worsening sleep quality . Poor sleep quality may cause exacerbations and mortality but it is not related with disease severity .…”