Impact of sleep in COPD

Sleep has well-recognized effects on breathing, including changes in centra l respiratory control, airways resistance, and muscular contractility, whic h do not have an adverse effect in healthy individuals but may cause proble ms in patients with COPD. Sleep-related hypoxemia and hypercapnia are well recognized in COPD and are most pronounced in rapid eye movement sleep. How ever, sleep studies are usually only indicated in patients with COPD when t here is a possibility of sleep apnea or when cor pulmonale and/or polycythe mia are not explained by the awake PaO2 level. Management options for patie nts with sleep-related respiratory failure include general measures such as optimizing therapy of the underlying condition; physiotherapy and prompt t reatment of infective exacerbations; supplemental oxygen; pharmacologic tre atments such as bronchodilators, particularly ipratropium bromide, theophyl line, and almitrine; and noninvasive positive pressure ventilation.