Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients

  1. Daniel SAMOLSKI1,*,
  2. Julia TÁRREGA1,
  3. Antonio ANTÓN1,
  4. Mercedes MAYOS1,4,
  5. Sergi MARTÍ2,4,
  6. Eva FARRERO3,
  7. Rosa GÜELL1

Article first published online: 23 NOV 2009

DOI: 10.1111/j.1440-1843.2009.01665.x

Issue

Respirology

Respirology

Volume 15, Issue 2, pages 283–288, February 2010

Additional Information

How to Cite

SAMOLSKI, D., TÁRREGA, J., ANTÓN, A., MAYOS, M., MARTÍ, S., FARRERO, E. and GÜELL, R. (2010), Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients. Respirology, 15: 283–288. doi: 10.1111/j.1440-1843.2009.01665.x

Author Information

  1. 1

    Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona,

  2. 2

    Respiratory Medicine Department, Hospital Vall d'Hebron, Barcelona, and

  3. 3

    Respiratory Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat,

  4. 4

    Ciber de Enfermedades Respiratorias (CIBERES), Spain

*Daniel Samolski, Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni Ma Claret Street, Barcelona 08025, Spain. Email: dsamolski@gmail.com

Publication History

  1. Issue published online: 26 JAN 2010
  2. Article first published online: 23 NOV 2009
  3. Received 18 June 2009; invited to revise 20 July 2009, 9 September 2009; revised 30 August 2009, 10 September 2009; accepted 15 September 2009 (Associate Editor: David Hui).

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Keywords:

  • chronic obstructive pulmonary disease;
  • chronic hypercapnic respiratory failure;
  • oxygen therapy;
  • sleep hypoventilation

This study shows the risks and benefits of increasing the nocturnal oxygen flow in hypercapnic COPD patients undergoing LTOT, as recommended by some COPD treatment guidelines to avoid nocturnal desaturation.

ABSTRACT

Background and objective:  Several COPD treatment guidelines recommend increasing oxygen flow during sleep to avoid nocturnal desaturation. However, such an increase could have deleterious clinical and gas exchange effects. The objective of this study was to evaluate short-term gas exchange alterations produced by increasing the nocturnal oxygen flow rate.

Methods:  Thirty-eight COPD patients with chronic hypercapnic respiratory failure were evaluated. In a cross-over study, patients were randomly assigned to receive the daytime oxygen flow rate on one night and an additional litre on the alternate night. Nocturnal pulse oximetry and arterial blood gases at awakening were measured, in each patient, on two consecutive days.

Results:  The administration of 1 L more oxygen during the night resulted in improved parameters of nocturnal oxygenation (oxygen pulse oximetry saturation—SpO2; percentage of sleep time spent at SpO2 < 90%—CT90; PaO2 at awakening). Nevertheless, such an increase in oxygen flow during the night was also associated with greater hypercapnia and acidosis (p < 0.05) the next morning.

Conclusions:  The increase of oxygen flow in severe COPD patients with established daytime hypercapnia improved nocturnal oxygenation but it also led to greater hypercapnia and respiratory acidosis at awakening in a considerable proportion of these patients.

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