COPD and Sleep Apnea (an overview)

Transcription

1 COPD and Sleep Apnea (an overview) Michael Zgoda, MD, MBA, FCCP Chief, Department of Medicine CMC-University Assoc. Prof. of Medicine, UNC Chapel-Hill

2 Case Presentation 65 yo female with 44 pack year tobacco smoking history, quit smoking ~10 years ago Presents with excessive daytime somnolence, snoring and witnessed apneas by her husband AF, 165/92, Resp 18, Pulse 91, SpO 2 94% (RA) 223lbs, 5 5, BMI 37.1, ESS 15 Metoprolol, ICS/LABA (Advair), Anticholinergic (Spiriva), Albuterol HFA (prn)

3 Diagnosis?

4 COPD

5 COPD 5

6 COPD and Sleep An early case series revealed that a high number of patients undergoing polysomnography for suspected SAHS were also noted to have COPD Guilleminault C, Cummiskey J, Motta J. Chronic obstructive airflow disease and sleep studies. Am Rev Respir Dis 1980;122:397

7 COPD and Sleep Several other reports suggested that the prevalence of SAHS in those with COPD is higher than would be expected in the general population. The Sleep Heart Health Study stated that in over 1130 participants with mild COPD there was no increased prevalence of SAHS. Chaouat A, Weitzenblum E, Krieger J, Ifoudza T, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am Rev Respir Dis 1995;151:82 86

8 COPD and Sleep Mild COPD (FEV1>70% predicted) Sleep quality was minimally impaired without SAHS Sleep Heart Health Study investigators recommended that if an individual has COPD with sleep-related symptoms, other sleep disorders such as periodic limb movements or SAHS should be considered Quan SF, Howard BV, Iber C, Kiley JP, Nieto FJ, O'Connor GT, Rapoport DM, Redline S, Robbins J, Samet JM, et al. The Sleep Heart Health Study: design, rationale, and methods. Sleep 1997;20:

9 COPD and Sleep Although the prevalence of SAHS was not higher in the participants with COPD, sleep quality and sleep desaturation was worse when participants had both COPD and SAHS Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, O'Connor GT, Punjabi NM, Shahar E, for the Sleep Heart Health Study. Sleep and sleepdisordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003;167:7

10 COPD and Sleep Individuals with COPD sleep badly Decreased Sleep Time Less REM More frequent changes in sleep stage Poor sleep quality is probably a major factor in their chronic fatigue and impaired QOL Breslin E, Van der Schans C, Breubink S, Meek P, Mercer K, Volz W, Louie S. Perception of fatigue and quality of life in patients with COPD. Chest 1998;114:

11 COPD and Sleep COPD patients demonstrate gas exchange abnormalities when asleep Desaturation occurs in all stages of sleep but maximum desaturations occur during REM even w/o SAHS Alveolar hypoventilation is thought to be the major mechanism Oxygen saturation while awake is the best predictor of desaturation during sleep Fleetham JA, Mezon B, West P, Bradley CA, Anthonisen NR, Kryger MH. Chemical control of ventilation and sleep arterial oxygen desaturation in patients with COPD. Am Rev Respir Dis 1980;122:

12 COPD and Sleep Hypoxia stimulates the reticular activating system and there is a strong association between hypoxemia and the incidence of arousals Supplemental Oxygen does not decrease arousals Suggesting that hypercapnea is the principal arousing stimulus Fleetham J, West P, Mezon B, Conway W, Roth T, Kryger M. Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. Am Rev Respir Dis 1982;126:429

13 COPD and Sleep FEV1/FVC < 65% Increased risk of oxygen desaturations independent of awake oxygen saturation and the presence of SAHS Sleep desaturation is associated with reduced survival and cannot be accurately predicted by symptoms or awake measurements Check nocturnal oximetry Fletcher EC, Donner CF, Midgren B, Zielinski J, Levi- Valensi P, Btaghirolo A, Ida Z, Miller CC. Survival in COPD patients with a daytime PaO 2 >60 mm Hg with and without nocturnal oxyhemoglobin desaturation. Chest 1992;101:

14 Nicotine and Sleep

15 Nicotine and Sleep

16 Nicotine and Sleep

17 Nicotine and Sleep

18 Case Treatment/Management

19 Questions