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Nocturnal ventilatory support in COPD

Peter C Gay, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD


Nocturnal alterations in gas exchange, such as oxygen desaturation and hypercapnia, are an important clinical problem in patients with chronic obstructive pulmonary disease (COPD). Potential forms of treatment include supplemental oxygen, pharmacologic agents, and nocturnal ventilatory support. (See "Sleep-related breathing disorders in COPD".)

The use of nocturnal ventilatory support in the management of patients with stable COPD will be reviewed here. The management of acute exacerbations of COPD and sleep-related breathing disorders in COPD are discussed separately. (See "Noninvasive ventilation in acute respiratory failure in adults" and "Sleep-related breathing disorders in COPD".)


In severe COPD, hypercapnia is largely due to poor matching of ventilation and perfusion, known as V/Q mismatch or dead space ventilation, which is a result of lung parenchyma and airway destruction. Some patients are able to partially compensate by increasing their minute ventilation, but others are not, possibly related to respiratory muscle weakness and other issues listed below.

Respiratory muscle weakness in patients with COPD probably results from a number of factors including the following [1]:

Change in configuration of the diaphragm caused by hyperinflation, which puts the diaphragm at a mechanical disadvantage

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Literature review current through: Nov 2017. | This topic last updated: Jun 28, 2017.
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