COPD sleep phenotypes: Genesis of respiratory failure in COPD

The chronic obstructive pulmonary disease (COPD) patients could have respiratory failure during sleep without daytime overt arterial blood gas (ABG) abnormality. We undertook a study first of its kind to attempt in distinguishing the underlying pathophysiological mechanisms. It was a prospective o...

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Autores principales:	Sameer Vaidya, Dipti Gothi, Mahismita Patro
Formato:	article
Lenguaje:	EN
Publicado:	PAGEPress Publications 2021
Materias:	COPD phenotypes, OSA, nocturnal hypoventilation, nocturnal oxygen desaturation Medicine R
Acceso en línea:	https://doaj.org/article/3e052823cdce421f9056da01024f0b6a
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spelling	oai:doaj.org-article:3e052823cdce421f9056da01024f0b6a2021-11-05T07:31:48ZCOPD sleep phenotypes: Genesis of respiratory failure in COPD10.4081/monaldi.2021.17761122-06432532-5264https://doaj.org/article/3e052823cdce421f9056da01024f0b6a2021-11-01T00:00:00Zhttps://monaldi-archives.org/index.php/macd/article/view/1776https://doaj.org/toc/1122-0643https://doaj.org/toc/2532-5264 The chronic obstructive pulmonary disease (COPD) patients could have respiratory failure during sleep without daytime overt arterial blood gas (ABG) abnormality. We undertook a study first of its kind to attempt in distinguishing the underlying pathophysiological mechanisms. It was a prospective observational study in stable COPD patients. The inclusion criterion was presence of day time PaO2>60 mmHg and PaCO2<45 mmHg. Twenty five out of 110 patients were excluded because of the ABG abnormality. The remaining 85 patients were subjected to overnight pulse oximetry and end-tidal (ET)-CO2 monitoring. The nocturnal oxygen desaturation was defined as per Fletcher’s criteria. The nocturnal hypoventilation was defined as per American academy of sleep medicine (AASM) guidelines. Patients having saw-tooth pattern on pulse oximetry and/or snoring were subjected to polysomnography. 38/85(44.8%) patients had nocturnal gas exchange abnormality in absence of daytime respiratory failure and were identified into 3 different phenotypes: obstructive sleep apnoea (OSA), nocturnal hypoventilation and nocturnal oxygen desaturation. The isolated abnormality was seen in 24 patients: 10 patients had OSA, 9 had nocturnal hypoventilation and 5 had nocturnal oxygen desaturation. Overlap of two or more phenotypes was seen in 14 patients. As compared to the nocturnal hypoventilation and desaturation phenotypes, the OSA phenotype had a significantly higher BMI & FEV1. The nocturnal hypoventilation and the desaturation phenotypes did not have significant difference in FEV1 and BMI, but the daytime SpO2 and PaO2 differed significantly. Such parameters could help in identifying the three distinct COPD-sleep phenotypes (OSA, nocturnal hypoventilation and nocturnal oxygen desaturation). A phenotype based nocturnal management may help in delaying the process of overt respiratory failure in COPD. Sameer VaidyaDipti GothiMahismita PatroPAGEPress PublicationsarticleCOPD phenotypes, OSA, nocturnal hypoventilation, nocturnal oxygen desaturationMedicineRENMonaldi Archives for Chest Disease (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COPD phenotypes, OSA, nocturnal hypoventilation, nocturnal oxygen desaturation Medicine R
spellingShingle	COPD phenotypes, OSA, nocturnal hypoventilation, nocturnal oxygen desaturation Medicine R Sameer Vaidya Dipti Gothi Mahismita Patro COPD sleep phenotypes: Genesis of respiratory failure in COPD
description	The chronic obstructive pulmonary disease (COPD) patients could have respiratory failure during sleep without daytime overt arterial blood gas (ABG) abnormality. We undertook a study first of its kind to attempt in distinguishing the underlying pathophysiological mechanisms. It was a prospective observational study in stable COPD patients. The inclusion criterion was presence of day time PaO2>60 mmHg and PaCO2<45 mmHg. Twenty five out of 110 patients were excluded because of the ABG abnormality. The remaining 85 patients were subjected to overnight pulse oximetry and end-tidal (ET)-CO2 monitoring. The nocturnal oxygen desaturation was defined as per Fletcher’s criteria. The nocturnal hypoventilation was defined as per American academy of sleep medicine (AASM) guidelines. Patients having saw-tooth pattern on pulse oximetry and/or snoring were subjected to polysomnography. 38/85(44.8%) patients had nocturnal gas exchange abnormality in absence of daytime respiratory failure and were identified into 3 different phenotypes: obstructive sleep apnoea (OSA), nocturnal hypoventilation and nocturnal oxygen desaturation. The isolated abnormality was seen in 24 patients: 10 patients had OSA, 9 had nocturnal hypoventilation and 5 had nocturnal oxygen desaturation. Overlap of two or more phenotypes was seen in 14 patients. As compared to the nocturnal hypoventilation and desaturation phenotypes, the OSA phenotype had a significantly higher BMI & FEV1. The nocturnal hypoventilation and the desaturation phenotypes did not have significant difference in FEV1 and BMI, but the daytime SpO2 and PaO2 differed significantly. Such parameters could help in identifying the three distinct COPD-sleep phenotypes (OSA, nocturnal hypoventilation and nocturnal oxygen desaturation). A phenotype based nocturnal management may help in delaying the process of overt respiratory failure in COPD.
format	article
author	Sameer Vaidya Dipti Gothi Mahismita Patro
author_facet	Sameer Vaidya Dipti Gothi Mahismita Patro
author_sort	Sameer Vaidya
title	COPD sleep phenotypes: Genesis of respiratory failure in COPD
title_short	COPD sleep phenotypes: Genesis of respiratory failure in COPD
title_full	COPD sleep phenotypes: Genesis of respiratory failure in COPD
title_fullStr	COPD sleep phenotypes: Genesis of respiratory failure in COPD
title_full_unstemmed	COPD sleep phenotypes: Genesis of respiratory failure in COPD
title_sort	copd sleep phenotypes: genesis of respiratory failure in copd
publisher	PAGEPress Publications
publishDate	2021
url	https://doaj.org/article/3e052823cdce421f9056da01024f0b6a
work_keys_str_mv	AT sameervaidya copdsleepphenotypesgenesisofrespiratoryfailureincopd AT diptigothi copdsleepphenotypesgenesisofrespiratoryfailureincopd AT mahismitapatro copdsleepphenotypesgenesisofrespiratoryfailureincopd
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COPD sleep phenotypes: Genesis of respiratory failure in COPD

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