Isolated nocturnal oxygen desaturation in pre-discharge inpatients with chronic obstructive pulmonary disease: prevalence and risk factors_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LI Kai , LI Guoping , LIAN Xiangzhong , SU Xian , QIAN Jiao

Respiratory Department of 3^rd People's Hospital of Chengdu, Chengdu, Sichuan 610031, P. R. China;

Corresponding?author：

LI Kai, Email: 31963623@qq.com

Keywords：

Chronic obstructive pulmonary disease; Nocturnal oxygen desaturation; Clinical screen; Risk factor

DOI：

10.7507/1671-6205.201710014

Video：

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Objective To investigate the prevalence and risk factors of isolated nocturnal oxygen desaturation (INOD) in pre-discharge inpatients with chronic obstructive pulmonary disease (COPD). Methods Totally 431 inpatients with COPD in this department were screened during January to June in 2017, in which pre-discharge inpatients without daytime hypoxia were enrolled in this study. Portable and wearable oximeter was used to record whole night oxygen saturation, pulse, hand movement of the inpatients within two days before being discharged. The clinical characters and symptoms, resting daytime artery gas analysis results, spirometry results, Epworth Sleepiness Score (ESS), Pittsburgh Sleep Quality Index (PSQI) were recorded and compared between INOD and non-INOD patients. Moreover, these data were furtherly compared between patients with or without suspected COPD-SAHS overlap syndrome (OS) to reveal the differences in clinical features. Logistics regression was used to find out independent predictors. Results One hundred and six pre-discharge inpatients without daytime hypoxia were screened out and out of them, 44 patients (41.5%) were proven with INOD. Patients with INOD presented lower daytime SaO₂ [(91.8±1.1)% vs. (94.4±1.5)%, P<0.05], moreover, the patients with suspected OS had a higher yearly exacerbation frequency (2.1±0.6 per yearvs. 1.4±0.4 per year, P<0.05), higher ESS score (10.5±2.7vs. 5.1±2.5, P<0.05) and PSQI (12.8±4.4vs. 7.4±3.1, P<0.05). Conclusions Even in pre-discharge COPD inpatients without daytime hypoxia, there is 41.5% of them suffering from unrevealed INOD. Lower daytime oxygen saturation and higher ESS indicate probable INOD and with higher exacerbation risk in OS patients. To screen out INOD in pre-discharge COPD is of clinical value and in need of attention.

Citation： LI Kai, LI Guoping, LIAN Xiangzhong, SU Xian, QIAN Jiao. Isolated nocturnal oxygen desaturation in pre-discharge inpatients with chronic obstructive pulmonary disease: prevalence and risk factors. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 533-539. doi: 10.7507/1671-6205.201710014 Copy

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2.	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(2): 133-138.
3.	Chaouat A, Weitzenblum E, Kessler R, et al. Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia. European Respiratory Journal, 1997, 10(8): 1730-1735.
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8.	張鳳蕊, 平芬, 韓書芝, 等. 老年慢性阻塞性肺疾病患者夜間經皮二氧化碳分壓、氧分壓及血氧飽和度的變化. 中國老年病學雜志, 2014, 35(20): 5849-5851.
9.	王一佳, 陶連琴, 時國朝, 等. 慢性阻塞性肺疾病無長期氧療指征患者夜間低氧血癥的日間相關因素分析. 中國呼吸與危重監護雜志, 2012, 11(4): 317-321.
10.	Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest, 2015, 147(1): 266-274.
11.	Jen R, Li YR, Owens RL, et al. Sleep in chronic obstructive pulmonary disease: evidence gaps and challenges. Can Respir J, 2016, 2016: 7947198.
12.	Fletcher EC, Luckett RA, Goodnight-White S, et al. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg. Am Rev Respir Dis, 1992, 145(5): 1070-1076.
13.	Cranston JM, Crockett AJ, Moss JR, et al. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2005, 19(4): CD001744.
14.	Long-Term Oxygen Treatment Trial Research Group, Albert RK, Au DH, et al. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med, 2016, 375(7): 1617-1627.
15.	Lacasse Y, Bernard S, Sériès F, et al. Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial. BMC Pulm Med, 2017, 17(1): 8.
16.	陳培鋒, 和平. 慢性阻塞性肺疾病夜間低氧血癥相關預測因素的臨床研究. 中國現代醫生, 2014, 52(8): 15-18.

1. Croxton TL, Bailey WC. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. Am J Respir Crit Care Med, 2006, 174(4): 373-378.
2. 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(2): 133-138.
3. Chaouat A, Weitzenblum E, Kessler R, et al. Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia. European Respiratory Journal, 1997, 10(8): 1730-1735.
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management and prevention of Chronic Obstructive Pulmonary Disease. (2017 REPORT). Available at: http://www.goldcopd.org.
5. American Thoracic Society and European Respiratory Society. Standards for the diagnosis and management of patients with COPD. Available at: http://dev.ersnet.org/275-guidelines.htm.
6. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南(基層版)編寫組. 阻塞性睡眠呼吸暫停低通氣綜合征診治指南(基層版). 中國呼吸與危重監護雜志, 2015, 14(4): 398-405.
7. Lacasse Y, Sériès F, Vujovic-Zotovic N, et al. Evaluating nocturnal oxygen desaturation in COPD--revised. Respir Med, 2011, 105(9): 1331-1337.
8. 張鳳蕊, 平芬, 韓書芝, 等. 老年慢性阻塞性肺疾病患者夜間經皮二氧化碳分壓、氧分壓及血氧飽和度的變化. 中國老年病學雜志, 2014, 35(20): 5849-5851.
9. 王一佳, 陶連琴, 時國朝, 等. 慢性阻塞性肺疾病無長期氧療指征患者夜間低氧血癥的日間相關因素分析. 中國呼吸與危重監護雜志, 2012, 11(4): 317-321.
10. Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest, 2015, 147(1): 266-274.
11. Jen R, Li YR, Owens RL, et al. Sleep in chronic obstructive pulmonary disease: evidence gaps and challenges. Can Respir J, 2016, 2016: 7947198.
12. Fletcher EC, Luckett RA, Goodnight-White S, et al. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg. Am Rev Respir Dis, 1992, 145(5): 1070-1076.
13. Cranston JM, Crockett AJ, Moss JR, et al. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2005, 19(4): CD001744.
14. Long-Term Oxygen Treatment Trial Research Group, Albert RK, Au DH, et al. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med, 2016, 375(7): 1617-1627.
15. Lacasse Y, Bernard S, Sériès F, et al. Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial. BMC Pulm Med, 2017, 17(1): 8.
16. 陳培鋒, 和平. 慢性阻塞性肺疾病夜間低氧血癥相關預測因素的臨床研究. 中國現代醫生, 2014, 52(8): 15-18.

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Isolated nocturnal oxygen desaturation in pre-discharge inpatients with chronic obstructive pulmonary disease: prevalence and risk factors

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