SLEEP QUALITY AND NOCTURNAL RESPIRATORY-FUNCTION WITH ONCE-DAILY THEOPHYLLINE (UNIPHYL) AND INHALED SALBUTAMOL IN PATIENTS WITH COPD

We compared the effects of evening administration of sustained-release theophylline (Uniphyl) and qid inhaled beta(2)-agonist (salbutamol, t wo 100-mu g puffs) on sleep quality and nocturnal oxygen saturation in 20 patients with COPD, Patients with FEV(1) less than 70% predicted a nd FEV(1)/FVC ratio less than 70% were eligible to participate in this double-blind, crossover study, with 2-week treatment arms, Patients r ecorded morning and evening peak flow and symptoms in a daily diary, O n the last day of each treatment period, overnight polysomnography was done, Spirometric indexes were measured before retiring and on awaken ing, Patients spent less time at. less than 90% oxygen saturation (51/-92 min vs 72+/-105 min; p=0.03) during theophylline treatments than during salbutamol treatment, There was a smaller overnight decrease in FEV(1) (0.04 L vs 0.13 L; p=0.04) after theophylline than after salbu tamol treatment, FEV(1)/FVC ratio and maximum expiratory flow at 50% o f vital capacity (V over dot (50)) increased overnight with theophylli ne and decreased with salbutamol (p=0.014, 0.025). Morning peak expira tory flow rate was higher with theophylline (4.0+/-1.7 L/s) than with salbutamol (3.6+/-1.8 L/s; p=0.004). The duration of patient-reported nocturnal wheezing was lower with theophylline than with salbutamol (p =0.006). There were no differences between treatments in sleep quantit y, efficiency, staging, or subjective quality. We conclude that, compa red with salbutamol, evening administration of once-daily theophylline results in better nocturnal oxygen saturation and an improvement in t he overnight change in pulmonary function, without affecting sleep arc hitecture, in patients with COPD.