Figures
- FIGURE 1
Interactions between COPD and obstructive sleep apnoea (OSA) that may influence the prevalence of the overlap syndrome. BMI: body mass index; REM: rapid eye movement.
- FIGURE 2
Different patterns of oxygen desaturation during sleep in patients with a) COPD, b) obstructive sleep apnoea and c) overlap syndrome. SaO2: arterial oxygen saturation; SpO2: arterial oxygen saturation measured by pulse oximetry; PtcCO2: transcutaneous carbon dioxide tension; REM: rapid eye movement.
- FIGURE 3
Sleep-related hypoventilation in COPD. Image shows ∼30 min of respiration during non-rapid and rapid eye movement (NREM and REM) sleep in a female patient with stable, advanced COPD. The level of arterial oxygen saturation (SaO2) and transcutaneous carbon dioxide tension (PtcCO2) is already reduced during NREM stage 2 sleep compared to values during wakefulness (SaO2 90%). No repetitive apnoea/hypopnea occurred. In the transition to REM sleep a physiological reduction in respiratory efforts (reduced amplitude in the thoracic effort signal) with a corresponding decrease in airflow amplitude occurred. A further reduction in SaO2 and a significant increase in PtcCO2 (a qualitative, non-calibrated signal) is the consequence of the REM sleep hypoventilation. Heart rate increases as an indirect sign of increased sympathetic activity.
- FIGURE 4
Pathophysiology of sleep-related hypoventilation in neuromuscular diseases. PaO2: arterial carbon dioxide tension.
Tables
- TABLE 1
Indications for performing a sleep diagnostic test in COPD patients
Symptoms or findings indicative for sleep disordered breathing in patients with COPD Sleep-related symptoms such as snoring, gasping and choking, as well as nocturia or morning headache Increased daytime sleepiness Signs of obesity including BMI >30 kg·m−2 in men and >35 kg·m−2 in women, neck circumference >43 cm in men and >41 cm in women Reduced daytime pulse oxygen saturation (<93%) at rest or during exercise Daytime hypercapnia Signs of pulmonary hypertension or right heart failure, such as peripheral oedema Polycythaemia Patients who use opioids and/or hypnotic medications Comorbidities such as atrial fibrillation, end-stage renal disease, type 2 diabetes, heart failure, difficult to treat hypertension and stroke BMI: body mass index.
- TABLE 2
Major neuromuscular and skeletal disorders that can provoke sleep hypoventilation
Neuromuscular diseases Skeletal chest wall diseases Guillain-Barré syndrome Kyphoscoliosis Myasthenia gravis Ankylosing spondylitis Poliomyelitis Post-polio syndrome Amyotrophic lateral sclerosis Cervical or thoracic spinal cord injury Polymyositis Muscular dystrophies
Jump To
- Article
- Abstract
- Abstract
- Introduction
- Physiological changes in ventilation during sleep
- Pathophysiology of sleep disordered breathing in COPD patients
- Factors influencing the association of COPD with OSA
- Assessment of SDB in COPD
- Treatment of sleep disordered treatment in COPD
- Research agenda for the treatment of SDB in COPD
- Sleep-related hypoventilation in neuromuscular and skeletal disorders
- SRH in neuromuscular disorders
- SRH in skeletal disorders
- Diagnosis of SRH
- Identification of patients at risk for SRH
- Treatment of SRH
- Footnotes
- References
- Figures & Data
- Info & Metrics