Indian Journal of Sleep Medicine

Register      Login

VOLUME 10 , ISSUE 1 ( January-March, 2015 ) > List of Articles

REVIEW ARTICLE

Sleep disorders in chronic obstructive pulmonary disease

Keywords : COPD, insomnia, restless leg syndrome, OSA, sleep hypoventilation, desaturation

Citation Information : Sleep disorders in chronic obstructive pulmonary disease. Indian Sleep Med 2015; 10 (1):11-21.

DOI: 10.5005/IJSM-10-1-11

License: NA

Published Online: 01-10-2012

Copyright Statement:  NA


Abstract

Sleep disorders in chronic obstructive pulmonary disease (COPD) can occur in 60-70% of patients. They have adverse outcome in terms of both morbidity and mortality of COPD. The various sleep disorders seen in COPD are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), nocturnal hypoventilation, and nocturnal oxygen desaturation (NOD). Of these disorders,insomnia and RLS can be diagnosed on history. OSA, sleep hypoventilation, and NODmay require type I polysomnography with/without transcutaneous or exhaled CO2 monitoring. Management consists of either conservative management or drug therapy for insomnia and RLS. If pharmacotherapy is required, ramelteon for insomnia and dopaminergic drug for RLS may be given. Treatment of OSA is continuous positive airway pressure, which relieves both OSA and COPD. Nocturnal hypoventilation usually requires oxygen along with noninvasive ventilator. Treatment of only NOD is controversial, but nocturnal oxygen may be given after ruling out nocturnal hypoventilation. This review emphasises the need of sleep disorders evaluation for comprehensive management of COPD.


PDF Share
  1. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS,et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397-412.
  2. Ezzie ME, Parsons JP, Mastronarde JG. Sleep and obstructive lung diseases. Sleep Med Clin. 2008;3:505-515.
  3. Budhiraja R, Siddiqi TA,Quan SF. Sleep disorders inchronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11:259-270.
  4. Sleep quality in COPD. Available at:http:// www.thoracic.org/copd-guidelines/for-healthprofessionals/ management-of-stable-copd/sleep/sleepproblems- in-copd.php(accessed on September 21, 2012).
  5. Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest. 1987;91:540-546.
  6. Klink ME, Dodge R, Quan SF. The relation of sleep complaints to respiratory symptoms in a general population. Chest. 1994;105:151-154.
  7. Lewis CA, Fergusson W, Eaton T, Zeng I, Kolbe. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax. 2009;64:133-138.
  8. Cormick W, Olson LG, Hensley MJ, Saunders NA. Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease. Thorax. 1986;41:846-854.
  9. Valipour A, Lavie P, Lothaller H, Mikulic I, Burghuber OC. Sleep profile and symptoms of sleep disorders in patients with stable mild to moderate chronic obstructive pulmonary disease. Sleep Med. 2011;12:367-372.
  10. Kinsman RA, Yaroush RA, Fernandez E, Dirks JF, Schocket M, Fukuhara J. Symptoms and experiences in chronic bronchitis and emphysema. Chest. 1983;83:755-761.
  11. Anzueto A, Ferguson GT, Feldman G, et al. Effect of fluticasone propionate/salmeterol (250/50) on COPD exacerbations and impact on patient outcomes. COPD. 2009;6:320-329.
  12. Tashkin DP, Rennard SI, Martin P, et al. Efficacy and safety of budesonide and formoterol in one pressurized metereddose inhaler in patients with moderate to very severe chronic obstructive pulmonary disease: results of a 6-month randomized clinical trial. Drugs. 2008;68:1975-2000.
  13. Price D, Small M, Milligan G, Higgins V, Gil EG, Estruch J. The prevalence and impact of night-time symptoms in COPD-a real-world study in five European countries. Int J Chron Obstruct Pulmon Dis.2013;8:595-603.
  14. Kaplan Y,Inonu H,Yilmaz A,Ocal S.Restless legs syndrome in patients with chronic obstructive pulmonary disease. Can J Neurol Sci. 2008;35:352-357.
  15. Lo Coco D, Mattaliano A, Lo Coco A, Randisi B. Increased frequency of restless legs syndrome in chronic obstructive pulmonary disease patients. Sleep Med.2009;10:572-576.
  16. Cavalcante AG, de Bruin PF, de Bruin VM, et al. Restless legs syndrome, sleep impairment, and fatigue in chronic obstructive pulmonary disease. Sleep Med. 2012;13: 842-847.
  17. Budhiraja R, Parthasarathy S, Budhiraja P, Habib MP, Wendel C, Quan SF. Insomnia in patients with COPD. Sleep. 2012;35:369-75.
  18. Lee R, McNicholas WT. Obstructive sleep apnea in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2011;17:79-83.
  19. Lacasse Y, Sériès F, Vujovic-Zotovic N, et al. Evaluating nocturnal oxygen desaturation in COPD revised. Respir Med.2011;105:1331-1337.
  20. INOX Trial Group. Characteristics of patients with COPD and nocturnal oxygen desaturation. Eur Resp J. 2014;44(Suppl 58):P3698.
  21. McNicholas WT. Impact of sleep in COPD. Chest.2000;117:48S-53S.
  22. Douglas NJ, White DP, Pickett CK, Weil JV, Zwillich CW. Respiration during sleep in normal man. Thorax. 1982;37:840-844.
  23. Krieger J, Turlot JC, Mangin P, Kurtz D. Breathing during sleep in normal young and elderly subjects: hypopneas, apneas andcorrelated factors. Sleep. 1983;6:108-120.
  24. Kerr HD. Diurnal variation of respiratory function independent of air quality. Arch Environ Health. 1973;26:144-153.
  25. Tusiewicz K, Moldofsky H, Bryan AC, Bryan MH. Mechanics of the ribcage and diaphragm during sleep. J Appl Physiol Respir Environ Excer Physiol. 1977;43:600-602.
  26. Agusti A, Hedner J, Marin JM,Barbé F.Cazzola M,Rennard S.Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011;20:183-194.
  27. Weitzenblum E, Chaouat A. Sleep and chronic obstructive pulmonary disease. Sleep Med Rev. 2004;8:281-294.
  28. American Academy of Sleep Medicine. The International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
  29. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487-504.
  30. Budhiraja R, Roth T, Hudgel DW, Budhiraja P, Drake CL. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. Sleep. 2011;34:859-867.
  31. Fleetham J, West P, Mezon B, Conway W, Roth T, Kryger M. Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy. Am Rev Respir Dis. 1982;126:429-433.
  32. Omachi TA, Blanc PD, Claman DM, et al. Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes. Sleep Med. 2012;13:476-483.
  33. Calverley PM, Brezinova V, Douglas NJ, Catterall JR, Flenley DC. The effect of oxygenation on sleep quality in chronic bronchitis and emphysema. Am Rev Respir Dis. 1982;126:206-210.
  34. Goldstein RS, Ramcharan V, Bowes G, McNicholas WT, Bradley D, Phillipson EA. Effect of supplemental nocturnal oxygen on gas exchange in patients with severe obstructive lung disease. N Engl J Med. 1984;310:425-429.
  35. McKeon JL, Murree-Allen K, Saunders NA. Supplemental oxygen and quality of sleep in patients with chronic obstructive lung disease. Thorax.1989;44:184-188.
  36. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14:9-15.
  37. Sica AL, Greenberg HE, Ruggiero DA, Scharf SM. Chronicintermittent hypoxia: a model of sympathetic activation in the rat. Respir Physiol. 2000;121:173-184.
  38. Schnell K, Weiss CO, Lee T, Krishnan JA, Leff B, Wolff JL, et al. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a crosssectional study using data from NHANES 1999-2008. BMC Pulm Med. 2012;12:26.
  39. Sundh J, Ställberg B, Lisspers K, Montgomery SM, Janson C. Co-morbidity, body mass index and quality of life in COPD using the Clinical COPD Questionnaire. COPD. 2011;8:173-181.
  40. Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40.
  41. Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415-1419.
  42. Kryger M, Roth T, Wang-Weigand S, Zhang J. The effects of ramelteon on respiration during sleep in subjects with moderate to severe chronic obstructive pulmonary disease. Sleep Breath. 2009;13:79-84.
  43. Nunes DM, Mota RM, Machado MO, Pereira ED, Bruin VM, Bruin PF. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res. 2008;41:926-923.
  44. GothiD. Restless legs syndrome: common yet an under recognized entity. Indian J Sleep Med. 2014;9:41-49.
  45. Aras G, Kadakal F,Purisa S,Kanmaz D,Aynaci A,Isik E. Are we aware of restless legs syndrome in COPD patients who are in an exacerbation period? Frequency and probable factors related to underlying mechanism. COPD.2011;8:437-443.
  46. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165:1286-1292.
  47. Allen RP, Stillman P, Myers AJ. Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: prevalence and characteristics. Sleep Med. 2010;11:31-37.
  48. Nichols DA, Allen RP, Grauke JH, et al. Restless legs syndrome symptoms in primary care: a prevalence study. Arch Intern Med. 2003;163:2323-2329.
  49. Leschziner G, Gringras P. Restless legs syndrome. BMJ. 2012;344:e3056.
  50. Winkelman JW, Finn L, Young T. Prevalence and correlates of restless legssyndrome symptoms in the Wisconsin Sleep Cohort. Sleep Med. 2006;7:545-552.
  51. Innes KE, Selfe TK, Agarwal P. Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: a systematic review. Sleep Med Rev. 2012;16:309–339.
  52. Walters AS. Toward a better definition of restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord. 1995;10:634–642.
  53. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–119.
  54. Hening W, Allen RP, Tenzer P, Winkelman JW. Restless legs syndrome: demographics, presentation, and differential diagnosis. Geriatrics. 2007;62:26–29.
  55. Byrne R, Sinha S, Chaudhuri KR. Restless legs syndrome: diagnosis and review of management options. Neuropsychiatr Dis Treat. 2006;2:155–164.
  56. Yoakum R. Night walkers. Do your legs seem to have a life of their own? Your torment has a name. Mod Maturity. 1994;55:82–84.
  57. Garcia-Borreguero D, Kohnen R, Silber MH,et al. The long-term treatment of restless legs syndrome/Willis– Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. Sleep Med. 2013;14:675–684.
  58. Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults-an update for 2012: practice parameters with an evidence-based systematic review and metaanalyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012;35:1039–1062.
  59. Owens RL,Malhotra A. Sleep-disordered breathing and COPD: theoverlap syndrome. Respir Care.2010;55:1333– 1346.
  60. Sanders MH, Newman AB, Haggerty CL, et al. Sleep and sleep disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med. 2003;167:7–14.
  61. Zamarrón C, Garcia Paz V, Morete E, Matías FC. Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences. Int J COPD. 2008;3:671–682.
  62. Pronzato C. Chronic obstructive pulmonary disease and obstructive sleep apnea. Association, consequences and treatment. Monaldi Arch Chest Dis. 2010;73:155–161.
  63. Budhiraja R, Kayyali US, Karamsetty M, et al. Estrogen modulates xanthine dehydrogenase/xanthine oxidase activity by a receptor-independent mechanism. Antioxid Redox Signal. 2003;5:705–711.
  64. Kayyali US, Budhiraja R, Pennella CM, et al. Upregulation of xanthine oxidase by tobacco smoke condensate in pulmonary endothelial cells. Toxicol Appl Pharmacol. 2003;188:59–68.
  65. Chaouat A, Weitzenblum E, Kessler R, et al. Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia. Eur Respir J. 1997;10:1730–1735.
  66. Hawrylkiewicz I, Sliwinski P, Gorecka D, Plywaczewski R, Zielinski J. Pulmonary haemodynamics in patients with OSAS or an overlap syndrome. Monaldi Arch Chest Dis. 2004;61:148–152.
  67. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis. Thorax. 2004;59:574–580.
  68. McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnea overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Am J Respir Crit Care Med. 2009;180:692–700.
  69. Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010;182:325–331.
  70. Mermigkis C, Kopanakis A, Foldvary-Schaefer N, et al. Health-related quality of life in patients with obstructive sleep apnoea and chronic obstructive pulmonary disease (overlap syndrome). Int J Clin Pract. 2007;61:207–211.
  71. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest. 1996;109:380–386.
  72. Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3:737–747.
  73. de Miguel J, Cabello J, Sánchez-Alarcos JM, Alvarez-Sala R, Espinós D, Alvarez-Sala JL. Long-term effects of treatment with nasal continuous positive airway pressure on lung function in patients with overlap syndrome. Sleep Breath. 2002;6:3–10.
  74. Peker Y, Hedner J, Johansson A, Bende M. Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment. Sleep. 1997;20:645–653.
  75. Machado MC, Vollmer WM, Togeiro SM, et al. CPAP and survival in moderate-to-severe obstructive sleep apnoea syndrome and hypoxaemic COPD. Eur Respir J. 2010;35:132–137.
  76. Kolodziej MA, Jensen L, Rowe B, Sin D. Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J. 2007;30:293-306.
  77. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597–619.
  78. O'Donoghue FJ, Catcheside PG, Ellis EE, et al. Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors. Eur Respir J. 2003;21:977-984.
  79. Tarrega J, Anton A, Guell R, et al. Predicting nocturnal hypoventilation in hypercapnic chronic obstructive pulmonary disease patients undergoing long-term oxygen therapy. Respiration. 2011;82:4-9.
  80. Piper AJ. Nocturnal hypoventilation-identifying & treating syndromes. Indian J Med Res.2010;131:350-365.
  81. Holmedahl NH, Øverland B, Fondenes O, Ellingsen I, Hardie JA. Sleep hypoventilation and daytime hypercapnia in stable chronic obstructive pulmonary disease. Int J Chron Obstruct Pulm Dis. 2014:9;265–275.
  82. Javaheri S, Shore NS, Rose B, Kazemi H. Compensatory hypoventiltion in metabolic alkalosis. Chest. 1982;81:296– 301.
  83. Cooper CB, Howard P. An analysis of sequential physiologic changes in hypoxic cor pulmonale during long-term oxygen therapy. Chest. 1991;100:76-80.
  84. McEvoy RD, Pierce RJ, Hillman D, et al. Nocturnal noninvasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax. 2009;64:561-566.
  85. Angelis GD, Sposato B, Mazzei L, et al. Predictive indexes of nocturnal desaturation in COPD patients not treated with long term oxygen therapy. Eur Rev Med Pharmacol Sci. 2001;5:173-179.
  86. Roussos C. Function and fatigue of respiratory muscles. Chest. 1985;88:124S-132S.
  87. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation-a consensus conference report. Chest. 1999;116:521-534.
  88. Díaz-Lobato S, Alises SM, Rodríguez EP. Current status of noninvasive ventilation in stable COPD patients. Int J Chron Obstruct Pulm Dis. 2006:1;129-135.
  89. Ekkernkamp E, Storre JH, Windisch W, Dreher M. Impact of intelligent volume assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study. Respiration. 2014;88:270–276.
  90. Fletcher EC, Scott D, Qian W, Luckett RA, Miller CC, Goodnight-White S. Evolution of nocturnal oxyhemoglobin desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 torr. Am Rev Respir Dis. 1991;144:401-425.
  91. Ramsey R, Mehra R, Strohl KP. Variations in physician interpretation of overnight pulse oximetry monitoring. Chest. 2007;132:852-859.
  92. Zhang J, Wang Y, Feng J, Sun X. Sleep induced hypoxemia in chronic obstructive pulmonary disease. JNMA J Nepal Med Assoc. 2013;52:528–533.
  93. Becker HF, Piper AJ, Flynn WE, et al. Breathing during sleep in patients with nocturnal desaturation. Am J Respir Crit Care Med. 1999;159:112–118.
  94. Poongkunran C, Budhiraja R. Sleep board review question: nocturnal hypoxemia in COPD. Southwest J Pulm Crit Care. 2013;6:12-14.
  95. Fletcher EC, Levin DC. Cardiopulmonary hemodynamics during sleep in subjects with chronic obstructive pulmonary disease. The effect of short- and long-term oxygen. Chest. 1984;85:6-14.
  96. Mueller PT, Gomes MD, Viegas CA, Neder JA. Systemic effects of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease without obstructive sleep apnea syndrome. J Bras Pneumol. 2008;34:567-574.
  97. Sergi M, Rizzi M, Andreoli A, Pecis M, Bruschi C, Fanfulla F. Are COPD patients with nocturnal REM sleep-related desaturations more prone to developing chronic respiratory failure requiring long-term oxygen therapy? Respiration. 2002;69:117-122.
  98. Perin C, Fagondes SC, Casarotto FC, Pinotti AF, Menna Barreto SS, Dalcin PdeT. Sleep findings and predictors of sleep desaturation in adult cystic fibrosis patients. Sleep Breath. 2012;16:1041-1048.
  99. McNicholas WT, Fitzgerald MX. Nocturnal deaths among patients with chronicbronchitis and emphysema. BMJ (Clin Res Ed). 1984;289:878.
  100. Fletcher EC, Donner CF, Midgren B, et al. Survival in COPD patients with a daytime PaO2 greater than 60 mm Hg with and without nocturnal oxyhemoglobin desaturation. Chest. 1992;101:649-655.
  101. O'Reilly P, Bailey W. Long-term continuous oxygen treatment in chronic obstructive pulmonary disease: proper use, benefits and unresolved issues. Curr Opin Pulm Med. 2007;13:120-124.
  102. Fletcher EC, Luckett RA, Goodnight-White S, Miller CC, Qian W, Costarangos-Galarza C. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg. Am Rev Respir Dis. 1992;145:1070-1076.
  103. Chaouat A, Weitzenblum E, Kessler R, et al. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients. Eur Respir J. 1999;14:1002- 1008.
  104. Cranston JM, Crockett AJ, Moss JR, Alpers JH. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005:CD001744.
  105. Krachman SL, Chatila W, Martin UJ, et al. Effects of lung volume reduction surgery on sleep quality and nocturnal gas exchange in patients with severe emphysema. Chest. 2005;128:3221-3228.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.