Sleep-related hypoventilation in COPD [Schlafbezogene Hypoventilationen bei COPD]

Sleep-related hypoventilation in COPD patients is caused by a variety of biochemical as well as mechanical factors that take effect during the transition from waking to sleeping, especially in REM sleep. Here especially sleep-related hypoventilation is considered, which occurs primarily in REM sleep and can result in pathological oxygen saturation levels and an increase in paCO2 levels. The effects of the nocturnal changes in blood gases have not been sufficiently analyzed (e.g., pathological increases in CO2 levels while sleeping) and in relation to the development of high blood pressure in the pulmonary circulation or even mortality in nocturnal hypoxemia are contradictory, which probably is caused by the lack of definitions of the degree of severity (e.g., nocturnal paCO2) or differing definitions of the degree of severity (e.g., for nocturnal oxygen saturation). In addition there are very short observation periods with regard to the problem of the emergence of PAP respectively mortality. The therapy of choice after all conservative methods have been tried is long-term oxygen therapy for predominantly pathological oxygen saturation. If there is evidence of fatigue of the respiratory pump, non-invasive ventilation therapy should be carried out. © Springer-Verlag 2012.