An overnight increase in CO2 predicts mortality in sleep disordered breathing

• Published in: Respirology (Carlton, Vic.) Vol. 17; no. 6; pp. 933 - 939
• Main Authors: BRILLANTE, RUBY, LAKS, LEON, COSSA, GAVINA, PETERS, MATTHEW, LIU, PETER
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.08.2012
• Subjects: Adult; Aged; Carbon Dioxide - blood; Cause of Death; Comorbidity; Female; gas exchange; Humans; hypercapnia; Hypercapnia - blood; Hypercapnia - epidemiology; Hypoxia - blood; Hypoxia - epidemiology; Male; Middle Aged; mortality; Overweight - epidemiology; Polysomnography; Prevalence; Pulmonary Gas Exchange - physiology; Respiratory Tract Diseases; Retrospective Studies; Risk Factors; Sleep Apnea Syndromes - mortality; sleep disordered breathing
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/j.1440-1843.2012.02209.x

ABSTRACT Background and objective:  Sleep disordered breathing (SDB) is highly prevalent but under‐recognized. Evidence is accumulating for its role as a predictor of mortality independent of cardiovascular risk factors. The role of hypercapnia in SDB is not known systematically, and between 11 and 43% of patients with SDB develop chronic hypercapnia. Hypercapnia predicts mortality in other respiratory conditions. The role of hypercapnia in independently predicting mortality in patients with SDB after assessing for the presence of airways disease and obesity was investigated. Methods:  The records of 396 consecutive patients were examined retrospectively. Univariate and multivariate analyses were performed using Cox proportional hazards regression to determine the association between gas exchange and polysomnography (PSG) variables and all‐cause mortality, adjusted for potential confounders, including age, gender and presence of co‐morbidity and airways disease. Results:  The mean age of our patient population was 55 ± 15 years, and the mean body mass index (BMI) was 30.6 ± 6.2 kg/m2. Out of the 322 patient population, 258 were men. After 10 years, 25% had died, following a maximum follow‐up of 16.7 years. Mortality among patients with SDB was predicted by a difference between evening and morning PaCO2 (ΔPaCO2) of ≥7 mm Hg and evening hypoxaemia (PaO2 < 65 mm Hg), independent of age and the presence of co‐morbidity and airways disease. There was a significant correlation between minimum oxygen saturation (SpO2) and ΔPaCO2 ≥ 7 mm Hg (P = 0.002) and evening PaO2 < 65 mm Hg (P < 0.001). Conclusions:  An overnight increase in CO2 and evening hypoxaemia are independent mortality predictors in SDB. A low minimum SpO2 identifies patients in whom morning and evening arterial blood gases are beneficial. The difference between evening and morning PaCO2 (ΔPaCO2) is a measure of hypercapnia. Mortality among patients with SDB after a follow‐up of ≤17 years was predicted by ΔPaCO2 of ≥7 mm Hg and evening hypoxaemia, independent of age and the presence of co‐morbidity and airways disease.