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Oxygen therapy in COPD patients with isolated nocturnal hypoxemia; comparison of quality of life and sleep between bronchitis and emphysema phenotype: A prospective observational study

Published:September 08, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.035

      Highlights

      • COPD is a complex syndrome composed by emphysema and bronchitic phenotypes.
      • nO2LT can modify sleep quality and quality of life in COPD patients.
      • There is a different response to nO2LT in the two COPD phenotypes.
      • Response to nO2LT during sleep in the two groups is better in COPDe than in COPDb.

      Abstract

      Background

      COPD is a heterogeneous disease composed by two main phenotypes: bronchitis (COPDb) and emphysema (COPDe) with different clinical presentation, physiology, imaging, response to therapy and decline in lung function.
      The aim of this study is to evaluate whether nocturnal hypoxemic COPDb and COPDe have a different behaviour during sleep and the effect of nocturnal oxygen supplementation (nO2LT).

      Materials and methods

      75 COPDb and 120 COPDe were enrolled. All patients performed polysomnography, Pittsburgh and Maugeri Foundation Respiratory Failure questionnaire, and pulmonary function before and after six months of nO2LT.

      Results

      At baseline, compared to COPDb, COPDe have decreased sleep efficiency (SE) (67.5 ± 6% vs. 76.9 ± 3% p < 0.05) and higher arousals (A/I) (18.1 ± 3 event/h vs. 8.7 ± 1 event/h p < 0.05). Oxygen desaturation index (ODI) was increased during REM (7.1 ± 1 event/h vs. 2.3 ± 0.5 event/h p < 0.05).
      nO2LT in COPDe improves SE (77 ± 4% vs. 67.5 ± 6% p < 0.05) and decreases A/I (9 ± 5 event/h vs. 18.1 ± 3 event/h p < 0.05). ODI during REM (3.5 ± 2 event/h vs. 7.1 ± 1 p < 0.05) decreases and quality of life (QoL) improves (MFR-28 total 56 ± 22 vs 45 ± 20 p < 0.05), due to an improvement in cognitive abilities (45 ± 30 vs 33 ± 31 p < 0.05) and daily activities (61 ± 29 vs 53 ± 21 p > 0.05). In COPDb nO2LT reduces ST90 (15 ± 6% vs. 43 ± 8% p < 0.05) less than in COPDe (15 ± 6% vs. 8 ± 4% p < 0.05); improves A/I (10 ± 2 event/h vs. 8.7 ± 1 p < 0.05) and there is no evidence of an improvement in QoL.

      Conclusions

      Six months of nO2LT improve quality of life in COPDe, not in COPDb. We found a difference in sleep quality between COPDe and COPDb.

      Keywords

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