Sleep and chronic obstructive pulmonary disease.
OBJECTIVE
Sleep disorders are pervasive in patients with chronic obstructive pulmonary disease (COPD). The patient with COPD is especially vulnerable to sleep-induced gas exchange aberrations. Most sleep disturbances affect the quality of life and some potentially affect survival in these patients. These issues impact treatment of these patients.


RESULTS
Insomnia is very common in COPD but might respond to inhaled anticholinergic agents. The use of hypnotics in the hypercapnic patient with severe COPD might be dangerous. The incidence of sleep apnea in COPD patients is allegedly very high, but recent studies suggest this association to be artifactual. Nocturnal oxygen desaturation, which is common in these patients, occurs even in mild COPD. This clinical complication might reflect sleep-disordered breathing or REM sleep-related hypoventilation. We need cost-effective and reliable methods to help distinguish between these causes without routinely resorting to formal polysomnography.


CONCLUSIONS
Development of sound clinical algorithms to address this clinical dilemma is indeed a focus for future research. Some of these patients might require continuous positive pressure therapy, whereas others might need long-term oxygen therapy. Although oxygen therapy in COPD patients with only mild hypoxemia and nocturnal desaturation has not uniformly been shown to be beneficial, it is perhaps too soon to abandon this important clinical intervention in these patients.
Kutty
Kesavan
K
Departments of Medicine, The Medical College of Wisconsin and St. Joseph Regional Medical Center, Milwaukee, Wisconsin, USA.
D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D007040:Hypoventilation / Q000209:etiology / Q000628:therapy; D000860:Hypoxia / Q000209:etiology* / Q000628:therapy; D010102:Oxygen Inhalation Therapy; D010108:Oxyhemoglobins / Q000737:chemistry; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D020186:Sleep Bruxism / Q000209:etiology / Q000628:therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000628:therapy; D012894:Sleep Stages
D006993:Hypnotics and Sedatives; D010108:Oxyhemoglobins