Abstract
Sleep disturbance related symptoms are common in patients with long-term oxygen therapy (LTOT). Essentially, there were only few previous reports about the sleep architecture in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD). This study aims to clarify the objective sleep state and the elements that affect sleep architecture in Chronic Respiratory Failure (CRF) patients with focus on clinical cases of chronic hypercapnia. 13 subjects with chronic respiratory failure were enrolled in the study. All the subjects were pre-evaluated by pulmonary function test and Arterial blood gas analysis (ABG) including exercise testing. Polysomnography (PSG) test was performed in each subject with supplemental oxygen. The estimated base line PaCO2 value that reflects overall PaCO2 including sleep period was calculated using equation of PaCO2[2.4×(HCOˉ3)-22]from obtained ABG value just before PSG test. 6 subjects were classified as hypercapnic group (base line PaCO2 ≥ 45 mmHg) and 7 subjects were non-hypercapnic group (base line PaCO2 2 were no significant difference. This study suggests that patients with estimated hypercapnia had more disturbed sleep architecture especially significant loss of sleep latency than non-hypercapnic patient with chronic respiratory failure under LTOT. Nocturnal PaCO2 level or ventilatory function may contribute to sleep disturbance in patients with estimated hypercapnia during LTOT.
Highlights
The goal of Long-Term Oxygen Therapy (LTOT) or Home Oxygen Therapy is to improve respiratory failure in patients with Chronic Respiratory Failure (CRF) and heart failure, which are defined by the partial pressure of arterial oxygen (PaO2), through maintaining a certain oxygen level at rest and during exertion and sleep [1,2,3]
This study suggests that patients with estimated hypercapnia had more disturbed sleep architecture especially significant loss of sleep latency than non-hypercapnic patient with chronic respiratory failure under LTOT
We evaluated the sleep architecture in CRF patients under LTOT using polysomnography (PSG) including electroencephalogram, investigated the clinical conditions of the patients focusing on the influence of hypercapnia on sleep architecture, and presented the findings below
Summary
Hypnotics for sleep improvement should be administered carefully in CRF patients who complain of insomnia and tend to have daytime drowsiness. For safe and rational treatment, it is essential to understand the sleep state in respiratory failure patients without the use of any agent that could influence sleep. Many studies have shown that hypoxemia during sleep causes arousal response and that sleep stages are associated with aggravation and improvement of hypoxemia in respiratory failure patients [13,14,15,16]. One report [17] on the influence of ventilatory failure and hypercapnia on sleep in healthy subjects has been published, the influence on sleep in patients with CRF is yet to be revealed.
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