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Sleep in chronic respiratory disease: COPD and hypoventilation disorders

Walter T. McNicholas, Daniel Hansson, Sofia Schiza, Ludger Grote
European Respiratory Review 2019 28: 190064; DOI: 10.1183/16000617.0064-2019
Walter T. McNicholas
1Dept of Respiratory Medicine, School of Medicine, University College Dublin, Dublin, Ireland
2First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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  • ORCID record for Walter T. McNicholas
  • For correspondence: walter.mcnicholas@ucd.ie
Daniel Hansson
3Sleep Disorders Centre, Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden
4Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Sofia Schiza
5Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
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Ludger Grote
3Sleep Disorders Centre, Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden
4Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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  • FIGURE 1
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    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
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    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
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    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.

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    FIGURE 4

    Pathophysiology of sleep-related hypoventilation in neuromuscular diseases. PaO2: arterial carbon dioxide tension.

Tables

  • Figures
  • 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 diseasesSkeletal chest wall diseases
      Guillain-Barré syndromeKyphoscoliosis
      Myasthenia gravisAnkylosing spondylitis
      Poliomyelitis
      Post-polio syndrome
      Amyotrophic lateral sclerosis
      Cervical or thoracic spinal cord injury
      Polymyositis
      Muscular dystrophies
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    Sleep in chronic respiratory disease: COPD and hypoventilation disorders
    Walter T. McNicholas, Daniel Hansson, Sofia Schiza, Ludger Grote
    European Respiratory Review Sep 2019, 28 (153) 190064; DOI: 10.1183/16000617.0064-2019

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    Sleep in chronic respiratory disease: COPD and hypoventilation disorders
    Walter T. McNicholas, Daniel Hansson, Sofia Schiza, Ludger Grote
    European Respiratory Review Sep 2019, 28 (153) 190064; DOI: 10.1183/16000617.0064-2019
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    • 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
    • PDF

    Subjects

    • COPD and smoking
    • Sleep medicine
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    More in this TOC Section

    • Central sleep apnoea and periodic breathing in heart failure
    • Insomnia management in sleep disordered breathing
    • Restless leg syndrome in the context of SDB comorbidity
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