Health> Vol.5 No.8B, August 2013
Downloads: 294     Views: 778

A study on sleep architecture in patients with chronic respiratory failure under long-term oxygen therapy—Focused on the influence of ventilatory failure (high CO2) elements on the patient’s sleep architecture

ABSTRACT

Sleep disturbance related symptoms are common in patients with long-term oxygen therapy (LTOT). Essentially, there were only few previous reports about the sleep architecture in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD). This study aims to clarify the objective sleep state and the elements that affect sleep architecture in Chronic Respiratory Failure (CRF) patients with focus on clinical cases of chronic hypercapnia. 13 subjects with chronic respiratory failure were enrolled in the study. All the subjects were pre-evaluated by pulmonary function test and Arterial blood gas analysis (ABG) including exercise testing. Polysomnography (PSG) test was performed in each subject with supplemental oxygen. The estimated base line PaCO2 value that reflects overall PaCO2 including sleep period was calculated using equation of PaCO2[2.4×(HCOˉ3)-22]from obtained ABG value just before PSG test. 6 subjects were classified as hypercapnic group (base line PaCO2 45 mmHg) and 7 subjects were non-hypercapnic group (base line PaCO2 < 45 mmHg). Latency persistent sleep of PSG data was significant higher in patients with hypercapnic than non-hypercapnic (p < 0.01). Periodic Limb Movement was seen in 23.6% of the subjects, however there was no contribution for arousals. Other PSG data include mean SpO2 were no significant difference. This study suggests that patients with estimated hypercapnia had more disturbed sleep architecture especially significant loss of sleep latency than non-hypercapnic patient with chronic respiratory failure under LTOT. Nocturnal PaCO2 level or ventilatory function may contribute to sleep disturbance in patients with estimated hypercapnia during LTOT.

KEYWORDS


Cite this paper

Nishijima, T. , Hosokawa, K. , Mito, F. , Kizawa, T. , Takahashi, S. , Kagami, H. , Suwabe, A. and Sakurai, S. (2013) A study on sleep architecture in patients with chronic respiratory failure under long-term oxygen therapy—Focused on the influence of ventilatory failure (high CO2) elements on the patient’s sleep architecture. Health, 5, 14-20. doi: 10.4236/health.2013.58A2003.

References

[1] Tarpy, S.P. and Celli, B.R. (1995) Long-term oxygen therapy. The New England Journal of Medicine, 333, 710-714. doi:10.1056/NEJM199509143331107
[2] Anthonisen, N.R. (1997) Long-term oxygen therapy in moderate hypoxaemia. Thorax, 52, 667-668. doi:10.1136/thx.52.8.667
[3] Petty, T.L. (1995) Ontroversial indications for long-term respiratory care: Long-term oxygen therapy. Monaldi Archives for Chest Disease, 54, 58-60.
[4] Croxton, T.L. and Bailey, W.C. (2006) Long-term oxygen treatment in chronic obstructive pulmonary disease: Recommendations for future research: An NHLBI workshop report. American Journal of Respiratory and Critical Care Medicine, 174, 373-378. doi:10.1164/rccm.200507-1161WS
[5] Rabe, K.F. and Hurd, S. (2007) Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine, 176, 532-555. doi:10.1164/rccm.200703-456SO
[6] Karachaliou, F. and Kostikas, K. (2007) Prevalence of sleep-related symptoms in a primary care population— Their relation to asthma and COPD. Primary Care Respiratory Journal, 16, 222-228. doi:10.3132/pcrj.2007.00045
[7] Janson, C. and Gislason, T. (1990) Sleep disturbances in patients with asthma. Respiratory Medicine, 84, 37-42. doi:10.1016/S0954-6111(08)80092-3
[8] Kantelip, J.P. and Magnin, P. (1989) Pharmacologic aspects of sleep disorders. Comptes Rendus des Seances de la Societe Biologie et ses Filiales, 183, 387-393.
[9] Tanaka, H. and Shuto, K. (1983) Muscle-relaxant effects of intravenously administered micronomicin. The Japanese Journal of Antibiotics, 36, 3268-3276.
[10] Remmers, J.E. and Anch, A.M. (1980) Oropharyngeal muscle tone in obstructive sleep apnea before and after strychnine. Sleep, 3, 447-453.
[11] Linnoila, M. and Viukari, M. (1980) Efficacy and side effects of lorazepam, oxazepam, and temazepam as sleeping aids in psychogeriatric inpatients. International Pharmacopsychiatry, 15, 129-135.
[12] Gaillard, J.M. (1977) Comparison of two muscle relaxant drugs on human sleep: Diazepam and parachlorophenylgaba. Acta psychiatrica Belgica, 77, 410-425.
[13] Mortola, J.P. (2007) Hypoxia and circadian patterns. Respiratory Physiology & Neurobiology, 158, 274-279. doi:10.1016/j.resp.2007.02.005
[14] Catcheside, P.G. and Orr, R.S. (2006) Mild hypoxia does not suppress auditory arousal from NREM sleep. Sleep, 29, 619-623.
[15] Fleetham, J. and West, P. (1982) Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy. American Review of Respiratory Disease, 126, 429-433.
[16] Fleetham, J.A. and Mezon, B. (1980) Chemical control of ventilation and sleep arterial oxygen desaturation in patients with COPD. American Review of Respiratory Disease, 122, 583-589.
[17] Iber, C. and Ancoli-Israel, S. (2007) The AASM Manual for the scoring of sleep and associated events AASM Manual for scoring sleep.
[18] Hudgel, D.W. and Kelaum, R. (2001) Depressed arousal response to airflow obstruction-possible factor in nearfatal nocturnal astma. Humana Press Inc.
[19] Martin, L. (1977) Respiratory failure. Medical Clinics of North America, 61, 1369-1396.
[20] Balk, R. and Bone, R.C. (1983) Classification of acute respiratory failure. Medical Clinics of North America, 67, 551-556.
[21] Newth, C.J. (1979) Recognition and management of respiratory failure. Pediatric Clinics of North America, 26, 617-643.
[22] Fleetham, J. and West, P. (1982) Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy. American Review of Resp ratory Disease, 126, 429-433.
[23] Montplaisir, J. and Walsh, J. (1982) Nocturnal asthma: Features of attacks, sleep and breathing patterns. American Review of Respiratory Disease, 125, 18-22.
[24] Gould, G.A. and Gugger, M. (1988) Breathing pattern and eye movement density during REM sleep in humans. American Review of Respiratory Disease, 138, 874-877. doi:10.1164/ajrccm/138.4.874
[25] Guilleminault, C. and Raynal, D. (1975) Sleep-related periodic myoclonus in patients complaining of insomnia. Transactions of the American Neurological Association, 100, 19-22.
[26] Coleman, R.M. and Roffwarg, H.P. (1982) Sleep-wake disorders based on a polysomnographic diagnosis. A national cooperative study. JAMA, 247, 997-1003. doi:10.1001/jama.1982.03320320033026
[27] Garcia, A.D. (2008) The effect of chronic disorders on sleep in the elderly. Clinics in Geriatric Medicine, 24, 27-38. doi:10.1016/j.cger.2007.08.008
[28] Mosko, S.S. and Nudleman, K.L. (1986) Somatosensory and brainstem auditory evoked responses in sleep-related periodic leg movements. Sleep, 9, 399-404.
[29] Lugaresi, E. and Coccagna, G. (1972) Some periodic phenomena arising during drowsiness and sleep in man. Electroencephalography and Clinical Neurophysiology, 32, 701-705. doi:10.1016/0013-4694(72)90106-X
[30] Roy, C. and Sherrington, C. (1890) On the regulation of the blood-supply of the brain. The Journal of Physiology, 11, 85-108.
[31] Bayliss, W.M. (1902) On the local reactions of the arterial wall to changes of internal pressure. The Journal of Physiology, 28, 220-231.
[32] Kety, S.S. (1957) Determinants of tissue oxygen tension. Federation Proceedings, 16, 666-671.
[33] Wolff, H. and Lennox, W. (1930) The cerebral corculation. The effect on pial vessels of variations in the O2 and CO2 content of the blood. Arch Neurol Psychiatry, 23, 1097-1120. doi:10.1001/archneurpsyc.1930.02220120002001
[34] Harper, A.M. and Glass, H.I. (1965) Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial blood pressures. Journal of Neurology, Neurosurgery & Psychiatry, 28, 449-452. doi:10.1136/jnnp.28.5.449
[35] Severinghaus, J.W. and Lassen, N. (1967) Step hypocapnia to separate arterial from tissue PCO2 in the regulation of cerebral blood flow. Circulation Research, 20, 272-278. doi:10.1161/01.RES.20.2.272
[36] Sokolff, L. (1960) The effect of carbon dioxide on the cerebral circulation. Anesthesiology, 21, 664-673. doi:10.1097/00000542-196011000-00010
[37] Lassen, N.A. (1966) Cerebral blood flow and metabolism in health and disease. Research Publications Association for Research in Nervous and Mental Disease, 41, 205-215.
[38] Purves, M.J. (1972) The physiology of the cerebral circulation. Monographs of the Physiological Society, 28, 1-414.

comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.