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BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access December 16, 2010

LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study

Ivan Kopitovic, Marija Kojicic, Mirjana Drvenica and Miroslav Ilic
From the journal Open Medicine

Abstract

Patients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p<0.0001; 1.7±0.3, p<0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists.

[1] Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001: 163(5): 1256–1276 10.1164/ajrccm.163.5.2101039Search in Google Scholar PubMed

[2] Lindberg E, Elmasry A, Gislason T, Janson C, Bengtsson H, Hetta J, Nettelbladt M, Boman G. Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med 1999: 159(6): 2024–2027 10.1164/ajrccm.159.6.9805070Search in Google Scholar PubMed

[3] McNicholas WT. Impact of sleep in COPD. Chest 2000: 117(2 Suppl): 48S–53S http://dx.doi.org/10.1378/chest.117.2_suppl.48S10.1378/chest.117.2_suppl.48SSearch in Google Scholar

[4] Weitzenblum E, Chaouat A, Kessler R, Canuet M. Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008: 5(2):237–241 http://dx.doi.org/10.1513/pats.200706-077MG10.1513/pats.200706-077MGSearch in Google Scholar PubMed

[5] Jelic S. Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea. Int J Chron Obstruct Pulmon Dis 2008: 3(2): 269–275 10.2147/COPD.S2168Search in Google Scholar PubMed PubMed Central

[6] Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA. Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 1985: 131(6): 835–839 Search in Google Scholar

[7] Chaouat A, Weitzenblum E, Krieger J, Ifoundza T, Oswald M, Kessler R. Association of chronic obstructive pulmonary disease and sleep apnea syndrome. Am J Respir Crit Care Med 1995: 151(1): 82–86 10.1164/ajrccm.151.1.7812577Search in Google Scholar PubMed

[8] Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J, Rubin AH. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995: 18(3): 149–157 10.1093/sleep/18.3.149Search in Google Scholar PubMed

[9] Hiestand D, Phillips B. The overlap syndrome: chronic obstructive pulmonary disease and obstructive sleep apnea. Crit Care Clin 2008: 24(3): 551–563, vii http://dx.doi.org/10.1016/j.ccc.2008.02.00510.1016/j.ccc.2008.02.005Search in Google Scholar PubMed

[10] McNicholas WT. COPD and Obstructive Sleep apnea: Overlaps in Pathophysiology, Systemic Inflammation and Cardiovascular Disease. Am J Respir Crit Care Med 2009 Search in Google Scholar

[11] Martin RJ, Cicutto LC, Smith HR, Ballard RD, Szefler SJ. Airways inflammation in nocturnal asthma. Am Rev Respir Dis 1991: 143(2): 351–357 10.1164/ajrccm/143.2.351Search in Google Scholar PubMed

[12] Martin RJ. Small airway and alveolar tissue changes in nocturnal asthma. Am J Respir Crit Care Med 1998: 157(5 Pt 2): S188–190 10.1164/ajrccm.157.5.rsaa-4Search in Google Scholar PubMed

[13] Wiegand L, Mende CN, Zaidel G, Zwillich CW, Petrocella VJ, Yancey SW, Rickard KA. Salmeterol vs theophylline: sleep and efficacy outcomes in patients with nocturnal asthma. Chest 1999: 115(6): 1525–1532 http://dx.doi.org/10.1378/chest.115.6.152510.1378/chest.115.6.1525Search in Google Scholar

[14] Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999: 22(5): 667–689 10.1093/sleep/22.5.667Search in Google Scholar

[15] Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, O’Connor GT, Punjabi NM, Shahar E. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003: 167(1): 7–14 http://dx.doi.org/10.1164/rccm.220304610.1164/rccm.2203046Search in Google Scholar

[16] Shaya FT, Lin PJ, Aljawadi MH, Scharf SM. Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome. Sleep Breath 2009 10.1007/s11325-009-0266-2Search in Google Scholar

[17] Engleman HM, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med 1999: 159(2): 461–467 10.1164/ajrccm.159.2.9803121Search in Google Scholar

[18] Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, Trinder J, Saunders NA, Douglas McEvoy R, Pierce RJ. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 2002: 165(6): 773–780 10.1164/ajrccm.165.6.2003166Search in Google Scholar

[19] Catterall JR, Calverley PM, MacNee W, Warren PM, Shapiro CM, Douglas NJ, Flenley DC. Mechanism of transient nocturnal hypoxemia in hypoxic chronic bronchitis and emphysema. J Appl Physiol 1985: 59(6): 1698–1703 10.1152/jappl.1985.59.6.1698Search in Google Scholar

[20] Sandek K, Andersson T, Bratel T, Lagerstrand L. Ventilation-perfusion inequality in nocturnal hypoxaemia due to chronic obstructive lung disease (COLD). Clin Physiol 1995: 15(5): 499–513 http://dx.doi.org/10.1111/j.1475-097X.1995.tb00539.x10.1111/j.1475-097X.1995.tb00539.xSearch in Google Scholar

[21] Ramirez-Venegas A, Ward J, Lentine T, Mahler DA. Salmeterol reduces dyspnea and improves lung function in patients with COPD. Chest 1997: 112(2): 336–340 http://dx.doi.org/10.1378/chest.112.2.33610.1378/chest.112.2.336Search in Google Scholar

[22] Barnes PJ. Effect of beta-agonists on inflammatory cells. J Allergy Clin Immunol 1999: 104(2 Pt 2): S10–17 http://dx.doi.org/10.1016/S0091-6749(99)70269-110.1016/S0091-6749(99)70269-1Search in Google Scholar

[23] Maris NA, de Vos AF, Dessing MC, Spek CA, Lutter R, Jansen HM, van der Zee JS, Bresser P, van der Poll T. Antiinflammatory effects of salmeterol after inhalation of lipopolysaccharide by healthy volunteers. Am J Respir Crit Care Med 2005: 172(7): 878–884 http://dx.doi.org/10.1164/rccm.200503-451OC10.1164/rccm.200503-451OCSearch in Google Scholar PubMed

[24] Sabater JR, Lee TA, Abraham WM. Comparative effects of salmeterol, albuterol, and ipratropium on normal and impaired mucociliary function in sheep. Chest 2005: 128(5): 3743–3749 http://dx.doi.org/10.1378/chest.128.5.374310.1378/chest.128.5.3743Search in Google Scholar PubMed

[25] Kerr HD. Diurnal variation of respiratory function independent of air quality: experience with an environmentally controlled exposure chamber for human subjects. Arch Environ Health 1973: 26(3): 144–152 10.1080/00039896.1973.10666242Search in Google Scholar PubMed

[26] Fitzpatrick MF, Mackay T, Driver H, Douglas NJ. Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist. BMJ 1990: 301(6765): 1365–1368 http://dx.doi.org/10.1136/bmj.301.6765.136510.1136/bmj.301.6765.1365Search in Google Scholar PubMed PubMed Central

[27] Rasche K, Duchna HW, Lauer J, Orth M, Kotterba S, Bauer TT, Gillissen A, Schultze-Werninghaus G. Obstructive Sleep Apnea and Hypopnea Efficacy and Safety of a Long-Acting beta2-Agonist. Sleep Breath 1999: 3(4): 125–130 http://dx.doi.org/10.1007/s11325-999-0125-110.1007/s11325-999-0125-1Search in Google Scholar PubMed

Published Online: 2010-12-16
Published in Print: 2011-2-1

© 2010 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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