Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD

• Published in: International journal of chronic obstructive pulmonary disease Vol. 13; pp. 843 - 853
• Main Authors: Kitajima, Takamasa, Marumo, Satoshi, Shima, Hiroshi, Shirata, Masahiro, Kawashima, Satoru, Inoue, Daiki, Katayama, Yuko, Itotani, Ryo, Sakuramoto, Minoru, Fukui, Motonari
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Activities of daily living; Albumin; Antibiotics; Blood gas analysis; Carbon dioxide; Care and treatment; Chronic obstructive lung disease; Chronic Obstructive Pulmonary Disease; Comparative analysis; Dyspnea; Hypercapnia; Hypertension; Hypoventilation; Laboratories; Medical imaging; Medical prognosis; Medical research; Nocturnal Hypoventilation; Non-invasive Positive Pressure Ventilation; Original Research; Oxygen saturation; Oxygen therapy; Patients; Pulmonary arteries; Pulmonary Hypertension; Pulse oximetry; Sleep; Sleep disorders; Veins & arteries; Japan; sleep disorders; nocturnal hypoventilation; pulmonary hypertension; intelligent volume-assured pressure support; noninvasive positive pressure ventilation; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S153200

Episodic nocturnal hypercapnia (eNH) caused by rapid eye movement (REM) sleep-related hypoventilation is often noted in patients with advanced COPD. The purpose of this study was to clarify the clinical significance of eNH and the effectiveness of eNH-targeted noninvasive positive pressure ventilation (NPPV). We enrolled patients with stable, severe, or very severe COPD with daytime arterial partial oxygen pressure PaO ≥55 mmHg and daytime arterial partial carbon dioxide pressure PaCO <55 mmHg, who underwent overnight transcutaneous carbon dioxide pressure (PtcCO ) monitoring from April 2013 to April 2016. We retrospectively compared clinical characteristics, daytime blood gas analysis, frequency of exacerbation, serum albumin levels, and ratio of pulmonary artery to aorta diameter (PA:A ratio), between patients with COPD with and without eNH. For those with eNH, we applied NPPV and compared these clinical characteristics before and after NPPV. Twenty-one patients were finally included in this study. Ten patients (47.6%) were evaluated to have eNH. These patients had lower albumin levels ( =0.027), larger PA:A ratio ( =0.019), and higher frequency of exacerbations during the last year ( =0.036). NPPV for the patients with eNH improved daytime PaCO compared with that 12 months after NPPV ( =0.011). The frequency of exacerbations 1 year before NPPV decreased 1 year after NPPV ( =0.030). Serum albumin levels improved 1 year after NPPV ( =0.001). In patients with stable severe or very severe COPD, eNH may be a risk factor of exacerbations, hypoalbuminemia, and pulmonary hypertension. NPPV may be effective against hypoalbuminemia and acute exacerbations. However, further study is necessary to validate these findings.