The changes of arterial oxygen saturation during sleep in chronic obstructive pulmonary disease patients. |
Ki Ho Jeong, Hyung Seok Choi, In Gyu Hyun, Dong Chull Choi, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Soo Shim, Keon Youl Kim, Yong Chol Han |
Department of Internal Medicine and Tuberculosis Reserch Institute, Seoul National University College of Medicine, Seoul, Korea |
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Abstract |
Frequently patients with chronic obstructive pulmonary disease have lowered arterial oxygen saturation in daytime. During sleep, they are apt to experience additional hypoxemia. These episodes of nocturnal hypoxemia are usually associated with periods of relative hypoventilation. Nocturnal hypoxemia may be associated with cardiac arrhythmia and with acute increase in pulmonary arterial pressure and may be implicated in the development of chronic pulmonary hypertension and cor pulmonale. We selected 14 patients with chronic obstructive pulmonary disease, 9 with emphysema dominant type and 5 with chronic bronchitis dominant type, to examine the frequency and severity of nocturnal hypoxemia and the effect of oxygen in prevention of nocturnal hypoxemia.
The results were as follows ;
1) On PFT, FVC, FEV 1 and FEV J FVC showed no significant difference between the emphysema dominant type (pink puffers, PP) and the chronic bronchitis dominant type (blue bloaters, BB). But DLCO/ V A for the PP group was 45.7 ± 15.1 % which was significantely different from BB group, 82.4± 5.6% .
2) The daytime arterial oxygen saturation (Sa02) and the lowest Sa02 during sleep for the BB group were significantly lower than for the PP group 3) The hypoxemic episodes during sleep were more frequent in BB group and the duration of hypoxemic episode was longer in BB group 4) In both group studied, although there was a tendency for a lower L-SaO2 (the lowest Sa02 during sleep), an increase in hypoxemic episodes and duration as the daytime Sa02 fell lower, the only parameter which showed significant correlation was daytime Sa02 and the frequency of hypoxemic episodes in the PP group (r=-0.68, P < 0.05) 5) In PP group, with oxygen supplementation, L-SaO2 during sleep showed significant increase, and there was a tendency for the frequency of hypoxemic episodes and duration to fall but it was not significant.
6) In BB group, oxygen supp1ementation significant1y increased the L-SaO2 during sleep and a1so significant1y decreased the frequency and duration of hypoxemic episode.
From these resu1ts, we can see that oxygen supp1ementation during sleep can prevent the decrease in SaO, to some extent and that this effect of oxygen can be seen more prominently in the BB group |
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