Chest
Volume 101, Issue 3, March 1992, Pages 649-655
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Survival in COPD Patients with a Daytime PaO2 >60 mm Hg with and without Nocturnal Oxyhemoglobin Desaturation

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There have been few studies examining the relationship between NOD and mortality in patients with COPD and none examining this relationship in those patients with a daytime PaO2 >60 mm Hg. Is NOD related to early death, and if so, should nocturnal supplemental oxygen be considered as therapy for altering survival? We examined survival in 169 COPD subjects. Two definitions were used to classify subjects as NOD and non-NOD, one considering episodic desaturation associated mainly with REM sleep (definition 1) and one considering >30 percent of time in bed spent below an SaO2 of 90 percent (definition 2) to be significant. Survival corrected for age was significantly better in non-NOD subjects. However, when stratified for supplemental oxygen use, survival remained better only in subjects separated by definition 1. There was a trend toward increased survival in 35 oxygen-treated vs 38 non-oxygen-treated NOD subjects (definition 1), but this difference was not statistically significant.

Section snippets

Patient Selection

This was a multicenter, retrospective study with data contributed from sleep centers focusing on the study of NOD in patients with COPD. The participating centers were asked to provide data for µp to 75 variables on each patient who met the following criteria:

  • 1.

    A nocturnal polysomnographic sleep recording was. available with calibrated ear or pulse oximetry to measure continuous SaO2 and electroencephalographic leads to verify sleep stages according to standard criteria.11 The patient had

RESULTS

Five centers submitted data on 178 subjects, 169 (161 males, 8 females) of whom met the inclusion criteria, had sufficient sleep data and provided follow-up data on each subject. The longest survival was 7 1/2 years and the shortest was one month. Median follow-up time for the entire group was 3.4 years.

DISCUSSION

This study provides from 6 months to 7 1/2 years of follow-up in 169 COPD patients in whom formal polysomnography with ear or finger plethysmographic sleep SaO2, blood gas values and spirometry were available from the point of inclusion. Thus, we were able to classify patients according to the pattern of nocturnal SaO2 and compare survival. Because of the lack of a standardized definition of NOD, we used two published criteria, one which incorporates criteria for episodic REM-related

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This is a cooperative study of the International Oxygen Club. The following are contributing centers: Eugene C. Fletcher, M.D., Associate Professor of Medicine, and Charles C. Miller III, Baylor College of Medicine, Houston, TX. Claudio F. Donner, M.D., Professor of Medicine, and Alberto Braghiroli, M.D., Divisione di Pneumologia, Centro Medico di Riabilitazione, Veruno, Italy. Bengt Midgren, M.D., Lund University Hospital, Lund, Sweden. Pierre Levi-Valensi, M.D., Professor of Medicine, and Ziad Rida, M.D., University of Picardie, C.H.U.— Hopital Sud Amiens, France. Jan Zielinski, M.D., Professor of Medicine, Department of Respiratory Medicine, Institute of Tuberculosis, Warsaw, Poland. Supported in part by the General Research Service of the Department of Veterans Affairs, the Swedish Heart and Lung Foundation (Dr. Midgren) and by individual grants from: DeVilbiss Health Care Inc., Somerset, PA; Healthdyne Technologies, Marietta, GA; Mountain Medical Inc., Denver, CO; and Puritan Bennett Inc., Lenexa, KS.

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