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Sleep-related breathing disorders in COPD

Hartmut Schneider, MD, PhD
Section Editors
James K Stoller, MD, MS
M Safwan Badr, MD
Deputy Editors
Helen Hollingsworth, MD
April F Eichler, MD, MPH


Chronic obstructive pulmonary disease (COPD) is frequently associated with sleep-related breathing disorders (SRBD), including sleep-related hypoxemia, obstructive sleep apnea, central sleep apnea, respiratory effort-related arousals (RERAs), and sleep-related hypoventilation. These SRBDs may be associated with nonrestorative sleep and daytime sleepiness and fatigue [1-10].  

The various forms of SRBD in COPD will be reviewed here, with special emphasis on (1) the diagnostic procedures required to detect the COPD-specific SRBD and (2) specific treatment options for SRBD in patients with COPD. A description of SRBD and the evaluation, diagnosis, and treatment of COPD and obstructive and central sleep apnea occurring independently are discussed separately. (See "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging" and "Management of stable chronic obstructive pulmonary disease" and "Polysomnography in the evaluation of sleep-disordered breathing in adults" and "Overview of obstructive sleep apnea in adults" and "Central sleep apnea: Risk factors, clinical presentation, and diagnosis" and "Central sleep apnea: Treatment".)


Sleep-related breathing disorders (SRBD) are common in patients with COPD [1], occurring in approximately 40 percent of patients [11,12].

There are four major domains of sleep-disordered breathing in COPD patients.

Sleep-related hypoxemia – The prevalence of sleep-related hypoxemia (also called nocturnal hypoxemia) increases along with the severity of COPD [2]. Sleep-related hypoxemia is often associated with daytime hypoxemia, but not always. Isolated sleep-related hypoxemia (fall in partial pressure of arterial oxygen [PaO2] of >10 mmHg or pulse oxygen saturation [SpO2] below 88 percent for more than five minutes) has been reported in up to 70 percent of COPD patients, and can occur in patients with daytime oxygen saturation of 90 to 95 percent [3,13].

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Literature review current through: Sep 2017. | This topic last updated: May 15, 2017.
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