Evaluating nocturnal oxygen desaturation in COPD – revised

SummaryBackgroundAlthough in patients with COPD, the approach to daytime hypoxemia using long-term oxygen therapy (LTOT) is established, the best approach to transient nocturnal desaturation varies among clinicians. An understanding of the prevalence of nocturnal desaturation in COPD, in the absence of other respiratory co-morbidities, is an important step towards its standardized management.MethodsWe conducted a 5 site cross-sectional study of stable patients with COPD and mild-to-moderate daytime hypoxemia (PaO2 56–69 mmHg). Nocturnal saturation was monitored using home oximetry on 2 occasions over a 2-week period. Patients were classified in 3 categories: (A) no significant nocturnal desaturation; (B) significant nocturnal desaturation without evidence of sleep apnea; (C) significant nocturnal desaturation with evidence of sleep apnea.ResultsIn 128 patients (mean FEV1: 37% predicted), we noted an excellent test-retest reliability between the 2 oximetries. Forty-nine patients (38%) were classified as nocturnal desaturators without evidence of sleep apnea, and 20 patients (16%) were classified as desaturators with evidence of sleep apnea. Nocturnal desaturation without sleep apnea could not be predicted by any patient characteristic or physiological measure.ConclusionsA significant proportion (38%) of patients with moderate-to-severe COPD who do not qualify for home oxygen therapy based on their daytime PaO2 have nocturnal oxygen desaturation without evidence of sleep apnea. Home oximetry is an effective practical method for screening this population.