Department of Respiratory and Sleep Medicine, Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.
Expert Rev Respir Med. 2014 Feb;8(1):79-88. doi: 10.1586/17476348.2014.860357. Epub 2013 Dec 30.
Sleep may have several negative consequences in patients with chronic obstructive pulmonary disease (COPD). Sleep is typically fragmented with diminished slow wave and rapid-eye-movement sleep, which likely represents an important contributing factor to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep, which result in mild hypoventilation in normal subjects, are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. The co-existence of obstructive sleep apnea and COPD is also common, principally because of the high prevalence of each disorder, and there is little convincing evidence that one disorder predisposes to the other. Nonetheless, this co-existence, termed the overlap syndrome, typically results in more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without obstructive sleep apnea.
慢性阻塞性肺疾病（COPD）患者的睡眠可能会产生若干负面影响。睡眠通常会出现片段化，慢波和快速眼动睡眠减少，这可能是导致白天疲劳和嗜睡等症状的重要因素。此外，在正常人群中，睡眠期间会出现轻度通气不足的正常生理适应，在 COPD 中更为明显，这可能导致临床意义上的夜间氧饱和度下降。阻塞性睡眠呼吸暂停和 COPD 同时存在也很常见，主要是因为这两种疾病的发病率都很高，而且几乎没有令人信服的证据表明一种疾病会导致另一种疾病。尽管如此，这种共存现象，称为重叠综合征，通常会导致更明显的夜间氧饱和度下降，此类患者中肺动脉高压的发病率也很高。COPD 患者睡眠障碍的治疗应同时解决睡眠质量和气体交换紊乱问题。在某些情况下，特别是在与呼吸衰竭相关的急性加重期，非侵入性压力支持是有益的，对重叠综合征患者尤其有帮助。在没有阻塞性睡眠呼吸暂停的 COPD 患者中，慢性环境下压力支持获益的证据有限。
