COPD sleep phenotypes: Genesis of respiratory failure in COPD

Foto di <a href=";utm_medium=referral&amp;utm_campaign=image&amp;utm_content=2803208">mcmurryjulie</a> da <a href=";utm_medium=referral&amp;utm_campaign=image&amp;utm_content=2803208">Pixabay</a>
Submitted: January 22, 2021
Accepted: August 10, 2021
Published: November 4, 2021
Abstract Views: 1383
PDF: 735
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


The chronic obstructive pulmonary disease (COPD) patients could have respiratory failure during sleep without daytime overt arterial blood gas (ABG) abnormality. We undertook a study first of its kind to attempt in distinguishing the underlying pathophysiological mechanisms.  It was a prospective observational study in stable COPD patients. The inclusion criterion was presence of day time PaO2>60 mmHg and PaCO2<45 mmHg. Twenty five out of 110 patients were excluded because of the ABG abnormality. The remaining 85 patients were subjected to overnight pulse oximetry and end-tidal (ET)-CO2 monitoring. The nocturnal oxygen desaturation was defined as per Fletcher’s criteria. The nocturnal hypoventilation was defined as per American academy of sleep medicine (AASM) guidelines. Patients having saw-tooth pattern on pulse oximetry and/or snoring were subjected to polysomnography. 38/85(44.8%) patients had nocturnal gas exchange abnormality in absence of daytime respiratory failure and were identified into 3 different phenotypes: obstructive sleep apnoea (OSA), nocturnal hypoventilation and nocturnal oxygen desaturation. The isolated abnormality was seen in 24 patients: 10 patients had OSA, 9 had nocturnal hypoventilation and 5 had nocturnal oxygen desaturation. Overlap of two or more phenotypes was seen in 14 patients. As compared to the nocturnal hypoventilation and desaturation phenotypes, the OSA phenotype had a significantly higher BMI & FEV1. The nocturnal hypoventilation and the desaturation phenotypes did not have significant difference in FEV1 and BMI, but the daytime SpO2 and PaO2 differed significantly.  Such parameters could help in identifying the three distinct COPD-sleep phenotypes (OSA, nocturnal hypoventilation and nocturnal oxygen desaturation). A phenotype based nocturnal management may help in delaying the process of overt respiratory failure in COPD.



PlumX Metrics


Download data is not yet available.


McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: the forgotten dimension. Eur Respir Rev 2013;22:365–75. DOI:
Gibson GJ. Clinical Tests of Respiratory Function. 3rd ed. London: Hodder Arnold; 2009. DOI:
Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 2011;6:199–208. DOI:
Sarkar M, Niranjan N, Banyal PK. Mechanisms of hypoxemia. Lung India 2017;34:47–60 DOI:
Flenley DC. Sleep in chronic obstructive lung disease. Clin Chest Med 1985;6:651–61. DOI:
Miller MR, Hankinson J, Brusasco V, et al. ATS/ERS task force: standardisation of lung function testing. Eur Respir J 2005;26:319–38. DOI:
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of COPD, 2018. Accessed on May 31, 2019. Available from:
No authors listed. 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;22:667-89. DOI:
Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11:259-70. DOI:
Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597–619. DOI:
Fletcher EC, Scott D, Qian W, et al. Evolution of nocturnal oxyhemoglobin desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 torr. Am Rev Respir Dis 1991;144:401-25. DOI:
Fletcher EC, Donner CF, Midgren B et al. Survival in COPD patients with a daytime PaO2 >60 mmHg with and without nocturnal oxyhaemoglobin desaturation. Chest 1992;101:649-55. DOI:
Angelis GD, Sposato B, Mazzei L, et al. Ondexes of nocturnal desaturation in COPD patients not treated with long term oxygen therapy. Eur Rev Med Pharmacol Sci 2001;5:173-9.
Chaouat A, Weitzenblum E, Kessler R, et al. Sleep related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia. Eur Respir J 1997;10:1730–5. DOI:
Fletcher EC, Schaaf JW, Miller J, et al. Long-term cardio-pulmonary sequelae in patients with sleep apnea and chronic lung disease. Am Rev Respir Dis 1987;135:525–33.
Lewis CA, Fergusson W, Eaton T, et al. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax 2009;64:133–8. DOI:
O'Donoghue FJ, Catcheside PG, Ellis EE, et al. Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors. Eur Respir J 2003;21:977–84. DOI:
Shawon MS, Perret JL, Senaratna CV, et al. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: a systematic review. Sleep Med Rev 2017, 32:58-68. DOI:
Scano G, Spinelli A, Duranti R, et al. Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia. Eur Respir J 1995;8:78–85. DOI:
Schreiber A, Cemmi F, Ambrosino N, et al. Prevalence and predictors of obstructive sleep apnea in patients with chronic obstructive pulmonary disease undergoing inpatient pulmonary rehabilitation. COPD 2018;15:265-70. DOI:
McNicholas WT. Comorbid obstructive sleep apnoea and chronic obstructive pulmonary disease and the risk of cardiovascular disease. J Thorac Dis 2018;10:S4253–61. DOI:

How to Cite

Vaidya, Sameer, Dipti Gothi, and Mahismita Patro. 2021. “COPD Sleep Phenotypes: Genesis of Respiratory Failure in COPD”. Monaldi Archives for Chest Disease 92 (2).