Abstract
COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.
Abstract
Sleep disordered breathing disorders, such as obstructive sleep apnoea, are common in patients with chronic respiratory diseases. Diagnosis is often challenging, but treatment options seem to improve outcomes. http://bit.ly/2LaJMlf
Footnotes
Provenance: Commissioned article, peer reviewed
Conflict of interest: W.T. McNicholas has nothing to disclose.
Conflict of interest: D. Hansson reports non-financial support from Itamar, during the conduct of the study.
Conflict of interest: S. Schiza has nothing to disclose.
Conflict of interest: L. Grote reports non-financial support from Itamar, personal fees from AstraZeneca, during the conduct of the study; and personal fees from Resmed, Philips, Fisher and Paykel, Itamar outside the submitted work. In addition, Dr. Grote has a patent on drug treatment in sleep apnea licensed.
- Received June 6, 2019.
- Accepted August 20, 2019.
- Copyright ©ERS 2019.
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.