PT  - JOURNAL ARTICLE
AU  - W.T. McNicholas
AU  - P.M.A. Calverley
AU  - A. Lee
AU  - J.C. Edwards
ED  - ,
TI  - Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD
AID  - 10.1183/09031936.04.00085804
DP  - 2004 Jun 01
TA  - European Respiratory Journal
PG  - 825--831
VI  - 23
IP  - 6
4099  - http://erj.ersjournals.com/content/23/6/825.short
4100  - http://erj.ersjournals.com/content/23/6/825.full
SO  - Eur Respir J2004 Jun 01; 23
AB  - 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 ≤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 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. This study was entirely supported by a grant from Boehringer Ingelheim Ltd.