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Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD

¹ St. Vincent's University Hospital, Elm Park, and ² Boehringer Ingelheim Ireland Ltd, Dublin, Ireland. ³ University Hospital Aintree, Liverpool, and ⁴ Boehringer Ingelheim Ltd, Bracknell, UK

CORRESPONDENCE: W.T. McNicholas, Dept of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Fax: 353 12697949. E-mail: walter.mcnicholas@ucd.ie

Keywords: Chronic obstructive pulmonary disease, randomised controlled trial, sleep-disordered breathing, tiotropium bromide

Received: July 24, 2003
Accepted March 15, 2004

This study was entirely supported by a grant from Boehringer Ingelheim Ltd.

Oxygen desaturation occurs during sleep in severe chronic obstructive pulmonary disease (COPD), especially during rapid eye movement (REM) sleep, due to hypoventilation and ventilation-perfusion mismatching, but the possible contribution of airflow limitation is unclear.

In a randomised, placebo-controlled, double-blind study of severe, stable COPD patients, the authors compared 4 weeks treatment with a long-acting inhaled anticholinergic agent (tiotropium), taken in the morning (tiotropium-AM), or in the evening (tiotropium-PM), on sleeping arterial oxygen saturation (S_a,O2) and sleep quality. Overnight polysomnography was performed at baseline and after 4 weeks treatment. A total of 95 patients with awake resting arterial oxygen tension 9.98 kPa (75 mmHg) were randomised, with a mean age of 66.4 yrs and mean forced expiratory volume in one second (FEV₁) of 32% predicted.

A total of 80 patients completed the study, of which 56 fulfilled the polysomnographic criterion of at least 2 h sleep in both sleep study nights and represent the group analysed. Tiotropium significantly improved spirometry compared with placebo. Both tiotropium-AM and tiotropium-PM groups had higher S_a,O2 during REM than placebo (+2.41% and +2.42%, respectively, and both pooled and tiotropium-PM groups had higher S_a,O2 during total sleep time (+2.49% and +3.06%, respectively). End-of-treatment FEV₁ correlated with S_a,O2 during REM sleep, however, tiotropium did not change sleep quality.

Sustained anticholinergic blockade improves sleeping arterial oxygen saturation without affecting sleep quality.

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