title: Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD.
abstract: Oxygen desaturation occurs during sleep in severe chronic obstructive pulmonary disease (COPD), especially during rapid eye movement (REM) sleep, due to hypoventilation and ventilation-perfusion mismatching, but the possible contribution of airflow limitation is unclear. In a randomised, placebo-controlled, double-blind study of severe, stable COPD patients, the authors compared 4 weeks treatment with a long-acting inhaled anticholinergic agent (tiotropium), taken in the morning (tiotropium-AM), or in the evening (tiotropium-PM), on sleeping arterial oxygen saturation (Sa,O2) and sleep quality. Overnight polysomnography was performed at baseline and after 4 weeks treatment. A total of 95 patients with awake resting arterial oxygen tension < or = 9.98 kPa (75 mmHg) were randomised, with a mean age of 66.4 yrs and mean forced expiratory volume in one second (FEV1) of 32% predicted. A total of 80 patients completed the study, of which 56 fulfilled the polysomnographic criterion of at least 2 h sleep in both sleep study nights and represent the group analysed. Tiotropium significantly improved spirometry compared with placebo. Both tiotropium-AM and tiotropium-PM groups had higher Sa,O2 during REM than placebo (+2.41% and +2.42%, respectively, and both pooled and tiotropium-PM groups had higher Sa,O2 during total sleep time (+2.49% and +3.06%, respectively). End-of-treatment FEV1 correlated with Sa,O2 during REM sleep, however, tiotropium did not change sleep quality. Sustained anticholinergic blockade improves sleeping arterial oxygen saturation without affecting sleep quality.
authors.affiliation: Dept of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. walter.mcnicholas@ucd.ie
authors.forename: W T
authors.initials: WT
authors.lastname: McNicholas
authors.forename: P M A
authors.initials: PM
authors.lastname: Calverley
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: J C
authors.initials: JC
authors.lastname: Edwards
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000008:administration & dosage / Q000627:therapeutic use*; D012894:Sleep Stages; D013147:Spirometry; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D018680:Cholinergic Antagonists; D012602:Scopolamine Derivatives; D010100:Oxygen; D000069447:Tiotropium Bromide