Abstract
Purpose
An increase in PaCO2 is the element that defines sleep hypoventilation (SH). We queried if patients with SH, and those with PaCO2 increases during sleep for shorter time periods than SH (shamSH) differed from the patients without SH (noSH) in other ways.
Methods
This was a retrospective re-analysis of data from 100 stable inpatients with COPD with and without chronic hypercapnic respiratory failure. COPD was defined by criteria of the Global initiative for Chronic Obstructive Lung Disease (GOLD). For this study, SH was defined by an increase in PaCO2 ≥ 1.33 kPa to a value exceeding 6.7 kPa for ≥ 10 min (≥ 20 epochs of 30 s). Patients fulfilling the increase in PaCO2 for less than 10 min (1–19 epochs) were designated shamSH. All patients had daytime arterial blood gases, lung function tests, and polysomnography (PSG) with transcutaneous CO2 (PtcCO2).
Results
Of 100 patients, 25 had PtcCO2 increase ≥ 1.33 kPa. One never exceeded 6.7 kPa, 15 had SH, and 9 shamSH. SH and shamSH patients had extra CO2 load (= PtcCO2*time) both during and between the SH periods compared to the noSH group, the SH group more than the shamSH group.
Conclusion
Using CO2 load as a measure of severity of sleep hypoventilation, SH patients have worse hypoventilation than the shamSH. Both shamSH and SH groups have extra CO2 load during and between SH periods, indicating that the SH/shamSH patients may represent a separate group of true hypoventilators during sleep.
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Funding
Financial support was received from the Norwegian Extra Foundation for Health and Rehabilitation, LHL’s Research fund, Glittreklinikken LHL helse as and the Norwegian national centre of excellence in home mechanical ventilation. Minor grants received from the Norwegian lung medicine society/Takeda Nycomed, Major Eckbo’s endowments and the University of Bergen.
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PSG hardware and software were provided by ResMed Norway.
Conflict of interest
This was not an industry-supported study. Nils H. Holmedahl received lecture honorarium from Glaxo Smith Kline and a grant from the Norwegian Lung Medicine Society/Takeda Nycomed. Britt Øverland, Ove Fondenes, and Ivar Ellingsen declare that they have no conflict of interest.
Ethical approval
Written informed consent was obtained from all individual participants included in the study. The study protocol was approved by the Regional Ethics Committee in south-eastern Norway (S-09053c 299/124). Clinical trial registration number: NCT00888342.
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Ellingsen, I., Fondenes, O., Øverland, B. et al. The severity of sleep hypoventilation in stable chronic obstructive pulmonary disease. Sleep Breath 25, 243–249 (2021). https://doi.org/10.1007/s11325-020-02097-y
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DOI: https://doi.org/10.1007/s11325-020-02097-y