Effect of ipratropium bromide treatment on oxygen saturation and sleep quality in COPD

Study objectives: Patients with CORD are at risk of experiencing a deterior ation in arterial oxygen saturation (SaO(2)) during sleep, which is general ly most pronounced during rapid eye movement (REM) sleep. Increased choline rgic tone has been suggested as a contributing factor to this decrease in S aO(2), Therefore, we investigated whether 4-week treatment with ipratropium bromide inhalation solution 0.02% (qid) could improve sleep characteristic s in COPD, Design: Randomized, placebo-controlled, double-blind, two-arm parallel stud y of 4 weeks of treatment with ipratropium bromide solution or placebo. Setting: Multicenter investigation. Patients: Thirty-six patients with moderate-to-severe COPD (FEV1 < 65% of p redicted). Measurements and results: Evaluation included polysomnographic, pulmonary function, and subjective quality of sleep (visual analog scale [V AS]) assessments. It was found that 4 week of treatment with ipratropium br omide solution in patients with COPD led to the following: (1) a significan t (p = 0.05) improvement in mean nocturnal SaO(2) with the more severe the nocturnal desaturation, the greater the improvement in SaO(2); (2) signific ant (p = 0.03) improvement in perceived sleep quality (VAS: 5.5 +/- 0.5 aft er placebo; 7.2 +/- 0.5 after ipratopium); (3) a significant (p = 0.05) inc rease in REM sleep time (48.6 +/- 6.3 min after placebo; 66.5 +/- 6.4 min a fter ipratropium) with no effect on other sleep stages or total sleep time; and (4) a significant (p = 0.01) increase in pre-sleep FVC and flow rate a t 50% of the vital capacity. Conclusions: These findings demonstrate that ipratropium bromide therapy ca n improve sleep SaO(2) as well as sleep quality in patients with moderate-t o-severe COPD.