Sposato B, Franco C
UOC Pneumologia, Azienda Ospedaliera Misericordia, Grosseto, Italy.
Eur Rev Med Pharmacol Sci. 2008 May-Jun;12(3):203-11.
Patients with stable chronic obstructive pulmonary disease (COPD) and diurnal PaO2 > 60 mmHg may have transient oxygen desaturation during sleep. The effect of bronchodilators on nocturnal hypoxemia is not known. The aim of this study was to evaluate if a single dose of Formoterol or Tiotropium, administered in the evening, could improve nocturnal hypoxemia in patients with stable middle/severe COPD. Thirty-seven patients (25 M/12 F; mean age 68.97 +/- 8.57, range 50-78; mean FEV1% of predicted 46.29 +/- 9.2) with PaO2 > 60 mmHg, but with significant oxygen desaturation during sleep and apnea/hypopnea index < or = 10 were selected. They randomly underwent three consecutive nocturnal pulsoxymetry: baseline and after taking placebo and 12 microg of Formoterol (20 pts) or 18 microg of Tiotropium (17 pts) in the evening. FEV1 and IC, measured after 1 h of taking bronchodilators, were significantly higher than placebo. The variation, with regards to baseline values, in mean heart rate and Lowest SpO2% measured after Tiotropium (-1.68 +/- 4.01 and 3.23 +/- 8.58 respectively) was higher (p < 0.05) than placebo (-0.108 +/- 2.85 and 0.29 +/- 7.05 respectively). Moreover, the trend time of SpO2% (measured by pulse-oximeter at each hour of total time registration) after Tiotropium was significantly higher than baseline or placebo (p < 0.01). Instead, the trend time of SpO2% after Formoterol, except for an initial transient hypoxemia fall, was similar to baseline condition and after placebo. Also the trend time of heart rate resulted significantly lower in the Tiotropium group, but higher in the Formoterol group. In conclusion, Formoterol does not seem to influence the nocturnal hypoxemia in stable COPD patients probably for the worsening V/Q ratio. On the contrary, a single dose of tiotropium seems to decrease the severity in the nocturnal desaturations in stable COPD patients probably due to the reduction in the nocturnal bronchial colinergic tone.
稳定期慢性阻塞性肺疾病（COPD）且日间动脉血氧分压（PaO2）>60 mmHg的患者在睡眠期间可能会出现短暂性氧饱和度下降。支气管扩张剂对夜间低氧血症的影响尚不清楚。本研究的目的是评估在晚上单次给予福莫特罗或噻托溴铵是否能改善稳定期中度/重度COPD患者的夜间低氧血症。选取了37例患者（25例男性/12例女性；平均年龄68.97±8.57岁，范围50 - 78岁；预计第一秒用力呼气容积（FEV1）平均百分比为46.29±9.2），其PaO2>60 mmHg，但睡眠期间存在明显的氧饱和度下降且呼吸暂停/低通气指数≤10。他们连续随机接受三次夜间脉搏血氧饱和度测定：基线值以及晚上服用安慰剂和12μg福莫特罗（20例患者）或18μg噻托溴铵（17例患者）之后的值。服用支气管扩张剂1小时后测得的FEV1和吸气量（IC）显著高于安慰剂组。与基线值相比，服用噻托溴铵后测得的平均心率和最低血氧饱和度百分比（SpO2%）的变化（分别为-1.68±4.01和3.23±8.58）高于安慰剂组（分别为-0.108±2.85和0.29±7.05）（p<0.05）。此外，服用噻托溴铵后SpO2%的趋势时间（在总时间记录的每小时通过脉搏血氧仪测量）显著高于基线或安慰剂组（p<0.01）。相反，除了最初短暂的低氧血症下降外，服用福莫特罗后SpO2%的趋势时间与基线情况及服用安慰剂后相似。心率的趋势时间在噻托溴铵组也显著降低，但在福莫特罗组升高。总之，福莫特罗似乎不影响稳定期COPD患者的夜间低氧血症，可能是因为通气/血流比值恶化。相反，单次剂量的噻托溴铵似乎能降低稳定期COPD患者夜间低氧饱和度的严重程度，可能是由于夜间支气管胆碱能张力降低。
