Kutty Kesavan
Departments of Medicine, The Medical College of Wisconsin and St. Joseph Regional Medical Center, Milwaukee, Wisconsin, USA.
Curr Opin Pulm Med. 2004 Mar;10(2):104-12. doi: 10.1097/00063198-200403000-00004.
Sleep disorders are pervasive in patients with chronic obstructive pulmonary disease (COPD). The patient with COPD is especially vulnerable to sleep-induced gas exchange aberrations. Most sleep disturbances affect the quality of life and some potentially affect survival in these patients. These issues impact treatment of these patients.
Insomnia is very common in COPD but might respond to inhaled anticholinergic agents. The use of hypnotics in the hypercapnic patient with severe COPD might be dangerous. The incidence of sleep apnea in COPD patients is allegedly very high, but recent studies suggest this association to be artifactual. Nocturnal oxygen desaturation, which is common in these patients, occurs even in mild COPD. This clinical complication might reflect sleep-disordered breathing or REM sleep-related hypoventilation. We need cost-effective and reliable methods to help distinguish between these causes without routinely resorting to formal polysomnography.
Development of sound clinical algorithms to address this clinical dilemma is indeed a focus for future research. Some of these patients might require continuous positive pressure therapy, whereas others might need long-term oxygen therapy. Although oxygen therapy in COPD patients with only mild hypoxemia and nocturnal desaturation has not uniformly been shown to be beneficial, it is perhaps too soon to abandon this important clinical intervention in these patients.
睡眠障碍在慢性阻塞性肺疾病（COPD）患者中普遍存在。COPD患者特别容易出现睡眠引起的气体交换异常。大多数睡眠障碍会影响这些患者的生活质量，有些还可能影响其生存。这些问题对这些患者的治疗产生影响。
失眠在COPD中非常常见，但可能对吸入抗胆碱能药物有反应。在重度COPD的高碳酸血症患者中使用催眠药可能很危险。据称COPD患者中睡眠呼吸暂停的发生率非常高，但最近的研究表明这种关联是人为造成的。夜间氧饱和度下降在这些患者中很常见，即使在轻度COPD患者中也会出现。这种临床并发症可能反映睡眠呼吸紊乱或快速眼动睡眠相关的通气不足。我们需要经济有效且可靠的方法来帮助区分这些原因，而不必常规进行正式的多导睡眠图检查。
开发合理的临床算法来解决这一临床难题确实是未来研究的重点。其中一些患者可能需要持续气道正压通气治疗，而另一些患者可能需要长期氧疗。虽然仅轻度低氧血症和夜间氧饱和度下降的COPD患者的氧疗尚未一致显示有益，但现在放弃对这些患者的这一重要临床干预可能为时过早。
