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The Proceedings of the American Thoracic Society 5:536-542 (2008)
© 2008 The American Thoracic Society
doi: 10.1513/pats.200708-134ET
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Sleep Abnormalities and Treatment in Emphysema

Samuel Krachman1, Omar A. Minai2 and Steven M. Scharf3

1 Sleep Disorders Center, Division of Pulmonary and Critical Care, Temple University School of Medicine, Philadelphia, Pennsylvania; 2 Division of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, Cleveland, Ohio; and 3 Sleep Disorders Center, Division of Pulmonary and Critical Care, University of Maryland, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Samuel Krachman, D.O., Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140. E-mail: krachms{at}tuhs.temple.edu

ABSTRACT

Sleep abnormalities are common in severe emphysema, and include poor sleep quality, the development of nocturnal oxygen desaturation, and the presence of coexistent obstructive sleep apnea. With lower baseline oxygenation and abnormal respiratory mechanics in patients with severe emphysema, alterations in ventilatory control and respiratory muscle function that normally occur during sleep can have profound effects, and contribute to the development of sleep abnormalities. The impact on quality of life, cardiopulmonary hemodynamics, and overall survival remains uncertain. In addition, treatment for chronic obstructive pulmonary disease and its effect on sleep abnormalities have demonstrated conflicting results. More recently, as part of the National Emphysema Treatment Trial, lung volume reduction surgery has been shown to improve both sleep quality and nocturnal oxygenation in emphysema. Although indications for performing an overnight polysomnogram in patients with emphysema have been debated, recommendations have been presented. Future studies investigating disease mechanism and response to therapy in patients with sleep abnormalities and severe emphysema are warranted.

Key Words: emphysema • sleep • hypoventilation • apnea • oxygenation






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