Twenty-four-hour ambulatory oximetry monitoring in COPD patients with moderate hypoxemia.
BACKGROUND
The relationship of diurnal desaturations (oximetry-measured blood oxygen saturation [S(pO(2))] < 90%) during activities of daily living and clinical aspects in patients with chronic obstructive pulmonary disease (COPD) and moderate hypoxemia has not been systematically evaluated.


METHODS
We prospectively studied 88 patients with stable COPD (forced expiratory volume in the first second [FEV(1)] < 80% of predicted, ratio of FEV(1) to forced vital capacity < 70% of predicted, and P(aO(2)) 60-70 mm Hg) with 24 hours of ambulatory oximetry. Desaturators were defined as those who spent >/= 30% of the time with S(pO(2)) < 90%. Patients engaged in their usual activities of daily living. We correlated these desaturations with the following variables, measured immediately before the 24 hours of oximetry: body mass index, dyspnea (measured with the modified Medical Research Council dyspnea scale), gas exchange, pulmonary function, quality of life (measured with the Saint George's respiratory questionnaire), and comorbidity (measured with the Charlson index).


RESULTS
Thirty-three (38%) of the patients were desaturators: 50% nocturnal and 22% diurnal. We also measured daytime arterial blood gas values from arterial blood samples and found that the desaturators had higher P(aCO(2)) (p = 0.001) and lower P(aO(2)) (p = 0.007) than the nondesaturators. There were no differences in the other variables. The correlation between nocturnal and diurnal time with S(pO(2)) < 90% was r(2) = 0.67, and the concordance was low (Cohen's kappa 0.43, p < 0.001).


CONCLUSIONS
Patients with stable COPD and moderate hypoxemia have frequent and potentially important desaturations during activities of daily living and at night. In addition, there is a big difference in the profile and degree of nocturnal and diurnal desaturations. Twenty-four hours of oximetry provides valuable information for comprehensive evaluation of patients with COPD.
Casanova
Ciro
C
Respiratory Research Institute, Hospital Universitario La, Candelaria, Carretera del Rosario s/n, 38010 Santa Cruz de Tenerife, Spain. ccasanova@canarias.org
Hernández
Ma Concepción
MC
Sánchez
Alejandro
A
García-Talavera
Ignacio
I
de Torres
Juan Pablo
JP
Abreu
Juan
J
Valencia
Jose Manuel
JM
Aguirre-Jaime
Armando
A
Celli
Bartolomé R
BR
D000203:Activities of Daily Living; D000368:Aged; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood* / Q000175:diagnosis; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood*
D010100:Oxygen