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  • Updated 01.23.2024
  • Released 11.22.1993
  • Expires For CME 01.23.2027

Sleep and chronic pulmonary disorders



Chronic pulmonary disorders are frequently associated with sleep-related abnormalities. The presence of these comorbidities contributes to the worsening of the poor quality of life in these patients and increases the risk of several other adverse health outcomes, including higher mortality. The authors explain the control of breathing during sleep in patients with chronic lung disorders, particularly chronic obstructive pulmonary disease, and discuss the impact of chronic lung disorders on nocturnal gas exchanges and sleep disturbances. The clinical importance of the overlap syndrome (association between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome) is discussed. In addition, the authors provide a review of consensus guidelines in the diagnosis and treatment of sleep disorders associated with these common conditions.

Key points

• Patients with chronic obstructive pulmonary disease frequently complain of sleep-related symptoms like unrefreshing sleep, insomnia, fatigue, and diurnal sleepiness.

• Studies during sleep show that in chronic obstructive pulmonary disease, patients’ oxyhemoglobin saturation is reduced from waking levels and sleep continuity is disrupted by arousals related to hypoventilation and hypoxemia.

• Management of sleep problems in chronic obstructive pulmonary disease should be primarily focused on optimizing the patient’s overall respiratory condition through correct treatment to ensure that poor symptom control is not the main cause of sleep disturbances.

• Long-term continuous oxygen therapy should be introduced to improve survival, sleep, and quality of life only in severe forms of chronic obstructive pulmonary disease with daytime resting PaO2 equal or less than 55 mm Hg.

• Sleep studies are usually not indicated in patients with chronic obstructive pulmonary disease except in special circumstances like the clinical suspicion of coexisting obstructive sleep apnea syndrome, as the presence of both conditions has negative implications with respect to prognosis.

Historical note and terminology

The modern study of breathing-related sleep disorders began with the demonstration that during sleep arterial pCO2 increases and pO2 decreases in normal subjects (81). Worsening hypoxemia during sleep in patients with chronic obstructive pulmonary disease has been documented since 1962 (96), but the first polysomnographic studies were performed more than 10 years later using intermittent measurements of arterial blood gases (46). Following the development of reliable oximeters, Flick and Block demonstrated the characteristic pattern of oxyhemoglobin desaturation in chronic obstructive pulmonary disease (30), and other investigators related the severe desaturations to REM sleep (21).

Lung diseases are classified as obstructive or restrictive based on the pattern of ventilatory impairment. In the International Classification of Sleep Disorders (02), sleep disorders associated with chronic lung disorders are classified in the field “Sleep-related breathing disorders” under the chapters “Sleep-related hypoxemia disorder” and “Sleep-related hypoventilation due to a medical disorder. The majority of studies address sleep disorders in common obstructive conditions, such as chronic obstructive pulmonary disease (COPD) and asthma. The limited data available about restrictive lung diseases mainly address idiopathic pulmonary fibrosis (IPF).

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