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Copyright ©ERS Journals Ltd 2004
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 (Sa,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
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 Sa,O2 during REM than placebo (+2.41% and +2.42%, respectively, and both pooled and tiotropium-PM groups had higher Sa,O2 during total sleep time (+2.49% and +3.06%, respectively). End-of-treatment FEV1 correlated with Sa,O2 during REM sleep, however, tiotropium did not change sleep quality.
Sustained anticholinergic blockade improves sleeping arterial oxygen saturation without affecting sleep quality.
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.
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