Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea

Respiratory Research

Han-Pin Kuo³  Shu-Chuan Ho²  Chao-Yung Wang¹  Yung-Lun Ni⁴  Ting-Yu Lin³  Shu-Min Lin³  Wen-Te Liu²  Kang-Yun Lee³  Yu-Lun Lo³  Tsai-Yu Wang³ 

[1] Department of Cardiology Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan;School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan;Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan;Department of Chest Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan

关键词: Continuous positive airway pressure;    Autonomic dysfunction;    Walking capacity;    Obstructive sleep apnoea;    Chronic obstructive pulmonary disease;   

Others  :  793261
DOI  :  10.1186/1465-9921-14-66

 received in 2013-02-11, accepted in 2013-06-17,  发布年份 2013

【 摘 要 】

Background

Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea.

Methods

Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment.

Results

After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564).

Conclusion

Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome.

Trial registration

NCT00914264

【 授权许可】

   
2013 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, et al.: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007, 176(6):532-555.
• [2]Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R: Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005, 171(9):972-977.
• [3]Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R: Physical activity and hospitalization for exacerbation of COPD. Chest 2006, 129(3):536-544.
• [4]Cooper CB: The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006, 119(10 Suppl 1):21-31.
• [5]Waschki B, Kirsten A, Holz O, Muller KC, Meyer T, Watz H, Magnussen H: Physical activity is the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease: a prospective cohort study. Chest 2011, 140(2):331-342.
• [6]Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM: Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006, 61(9):772-778.
• [7]Wegner RE, Jorres RA, Kirsten DK, Magnussen H: Factor analysis of exercise capacity, dyspnoea ratings and lung function in patients with severe COPD. Eur Respir J 1994, 7(4):725-729.
• [8]Dam TT, Ewing S, Ancoli-Israel S, Ensrud K, Redline S, Stone K: Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc 2008, 56(9):1665-1673.
• [9]Leggett RJ, Flenley DC: Portable oxygen and exercise tolerance in patients with chronic hypoxic cor pulmonale. Br Med J 1977, 2(6079):84-86.
• [10]Davidson AC, Leach R, George RJ, Geddes DM: Supplemental oxygen and exercise ability in chronic obstructive airways disease. Thorax 1988, 43(12):965-971.
• [11]Hurst JR, Donaldson GC, Perera WR, Wilkinson TM, Bilello JA, Hagan GW, Vessey RS, Wedzicha JA: Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006, 174(8):867-874.
• [12]Kent BD, McNicholas WT, Verbraecken J: Disturbed sleep and COPD outcomes: cart meets horse. Sleep Med 2012, 13(5):453-454.
• [13]Marklund M, Verbraecken J, Randerath W: Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J 2012, 39(5):1241-1247.
• [14]Basner RC: Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med 2007, 356(17):1751-1758.
• [15]Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA: Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008, 4(2):157-171.
• [16]EEG arousals: Scoring rules and examples: a preliminary report from the sleep disorders atlas task force of the american sleep disorders association. Sleep 1992, 15(2):173-184.
• [17]Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. the report of an american academy of sleep medicine task force. Sleep 1999, 22(5):667-689.
• [18]Rosano TG, Swift TA, Hayes LW: Advances in catecholamine and metabolite measurements for diagnosis of pheochromocytoma. Clin Chem 1991, 37(10 Pt 2):1854-1867.
• [19]Rosano TG: Liquid-chromatographic evaluation of age-related changes in the urinary excretion of free catecholamines in pediatric patients. Clin Chem 1984, 30(2):301-303.
• [20]Liu WT, Wang CH, Lin HC, Lin SM, Lee KY, Lo YL, Hung SH, Chang YM, Chung KF, Kuo HP: Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J 2008, 32(3):651-659.
• [21]Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE: Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992, 47(12):1019-1024.
• [22]Weitzenblum E, Chaouat A, Kessler R, Canuet M, Hirschi S: The overlap syndrome: association of COPD and obstructive sleep apnoea. Rev Mal Respir 2010, 27(4):329-340.
• [23]Aihara K, Oga T, Harada Y, Chihara Y, Handa T, Tanizawa K, Watanabe K, Tsuboi T, Hitomi T, Mishima M, et al.: Comparison of biomarkers of subclinical lung injury in obstructive sleep apnea. Respir Med 2011, 105(6):939-945.
• [24]Singh SJ, Jones PW, Evans R, Morgan MD: Minimum clinically important improvement for the incremental shuttle walking test. Thorax 2008, 63(9):775-777.
• [25]Prohaska TR, Eisenstein AR, Satariano WA, Hunter R, Bayles CM, Kurtovich E, Kealey M, Ivey SL: Walking and the preservation of cognitive function in older populations. Gerontologist 2009, 49(Suppl 1):S86-93.
• [26]McGuire M, MacDermott M, Bradford A: Effects of chronic intermittent asphyxia on rat diaphragm and limb muscle contractility. Chest 2003, 123(3):875-881.
• [27]Chien MY, Wu YT, Lee PL, Chang YJ, Yang PC: Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea. Eur Respir J 2010, 35(2):373-380.
• [28]Mougin F, Simon-Rigaud ML, Davenne D, Renaud A, Garnier A, Kantelip JP, Magnin P: Effects of sleep disturbances on subsequent physical performance. Eur J Appl Physiol Occup Physiol 1991, 63(2):77-82.
• [29]Lin CC, Hsieh WY, Chou CS, Liaw SF: Cardiopulmonary exercise testing in obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2006, 150(1):27-34.
• [30]Narkiewicz K, Kato M, Phillips BG, Pesek CA, Davison DE, Somers VK: Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation 1999, 100(23):2332-2335.
• [31]Ketelaars CA, Schlösser MA, Mostert R, Huyer Abu-Saad H, Halfens RJ, Wouters EF: Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease. Thorax 1996, 51(1):39-43.
• [32]Middlekauff HR: Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circ Heart Fail 2010, 3(4):537-546.
• [33]Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR: Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med 2010, 182(3):325-331.
• [34]Cote CG, Pinto-Plata V, Kasprzyk K, Dordelly LJ, Celli BR: The 6-min walk distance, peak oxygen uptake, and mortality in COPD. Chest 2007, 132(6):1778-1785.
• [35]Goddard PR, Nicholson EM, Laszlo G, Watt I: Computed tomography in pulmonary emphysema. Clin Radiol 1982, 33(4):379-387.
• [36]Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, Wellman A, Schory K, Dover L, White DP: Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax 2006, 61(5):435-439.