Predictors of nocturnal oxyhemoglobin desaturation in COPD

Abstract

It would be useful to detect predictors of marked nocturnal oxyhemoglobin desaturation (NOD) among COPD patients, who do not have respiratory failure when awake and sleep apnea (SA). Stable COPD patients with awake Pa(O2) ≥ 60 mmHg and Pa(CO2) ≤ 45 mmHg underwent cardio-respiratory polysomnography to exclude SA and to assess NOD. The patients that spent more than 30% of night time with Sp(O2) < 90%, were defined desaturators (D), and the others non desaturators (ND). Pulmonary function testing was performed to determine lung volumes, maximal flow rates, lung diffusion capacity for carbon monoxide and maximal inspiratory and expiratory pressure (P(Imax) and P(Emax)). Negative expiratory pressure test was performed to assess tidal expiratory flow limitation. Supine pharyngometry was performed to determine upper airway size, shuttle walking test to assess exercise desaturation. Twenty-one patients were included in the study (18 male, age 66.0±7.2 years, Body Mass Index 25.9±4.4 kg/m(2), FEV(1) 47.2±16.4% pred., Pa(O2) 74.7±6.9 mmHg, Pa(CO2) 40.3±3.4 mmHg): 10 were D and 11 ND. Significant differences between the two groups were found in diurnal Pa(CO2) (D: 42.4±3.0 vs. ND: 38.3±2.6mmHg; p<0.01), diurnal Sp(O2) (D: 94.0±1.5 vs. ND: 95.9±0.9%; p<0.01), inspiratory capacity (IC) (D: 69.6±11.9 vs. ND: 87.0±17.7% pred.; p<0.05), and oro-pharyngeal junction area (OPJ) (D: 0.8±0.2 vs. ND: 1.2±0.3 cm(2); p<0.01). Among parameters related to marked NOD at the univariate analysis, [Formula: see text] and OPJ remained as independent predictors after stepwise multiple regression analysis. These findings indicate that previously unrecognized factors such as smaller upper airway caliber and lung dynamic hyperinflation are associated with marked NOD in stable COPD patients without daytime respiratory failure and SA.