Nicolle J Domnik1,2, Devin B Phillips1, Matthew D James1, Grace A Ayoo1, Sarah M Taylor1, Robin E Scheeren1, Amanda T Di Luch1, Kathryn M Milne1, Sandra G Vincent1, Amany F Elbehairy1,3,4, Sophie J Crinion1,5,6, Helen S Driver1,5,6, J Alberto Neder1,6, Denis E O'Donnell7,8,9. 1. Department of Medicine, Queen's University, Kingston, Canada. 2. Department of Physiology and Pharmacology, Western University, London, Canada. 3. Manchester University NHS Foundation Trust, Manchester, UK. 4. Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt. 5. Sleep Disorders Laboratory, Kingston Health Sciences Centre, Kingston, Canada. 6. Division of Respiratory Medicine, Queen's University, Kingston, Canada. 7. Department of Medicine, Queen's University, Kingston, Canada. odonnell@queensu.ca. 8. Division of Respiratory Medicine, Queen's University, Kingston, Canada. odonnell@queensu.ca. 9. Respiratory Investigation Unit, Kingston Health Sciences Centre, 102 Stuart St, Kingston, ON, K7L 2V7, Canada. odonnell@queensu.ca.
Abstract
PURPOSE: To assess whether night-time increases in mechanical loading negatively impact respiratory muscle function in COPD and whether compensatory increases in inspiratory neural drive (IND) are adequate to stabilize ventilatory output and arterial oxygen saturation, especially during sleep when wakefulness drive is withdrawn. METHODS: 21 patients with moderate-to-severe COPD and 20 age-/sex-matched healthy controls (CTRL) participated in a prospective, cross-sectional, one-night study to assess the impact of COPD on serial awake, supine inspiratory capacity (IC) measurements and continuous dynamic respiratory muscle function (esophageal manometry) and IND (diaphragm electromyography, EMGdi) in supine sleep. RESULTS: Supine inspiratory effort and EMGdi were consistently twice as high in COPD versus CTRL (p < 0.05). Despite overnight increases in awake total airways resistance and dynamic lung hyperinflation in COPD (p < 0.05; not in CTRL), elevated awake EMGdi and respiratory effort were unaltered in COPD overnight. At sleep onset (non-rapid eye movement sleep, N2), EMGdi was decreased versus wakefulness in COPD (- 43 ± 36%; p < 0.05) while unaffected in CTRL (p = 0.11); however, respiratory effort and arterial oxygen saturation (SpO2) were unchanged. Similarly, in rapid eye movement (stage R), sleep EMGdi was decreased (- 38 ± 32%, p < 0.05) versus wakefulness in COPD, with preserved respiratory effort and minor (2%) reduction in SpO2. CONCLUSIONS: Despite progressive mechanical loading overnight and marked decreases in wakefulness drive, inspiratory effort and SpO2 were well maintained during sleep in COPD. Preserved high inspiratory effort during sleep, despite reduced EMGdi, suggests continued (or increased) efferent activation of extra-diaphragmatic muscles, even in stage R sleep. CLINICAL TRIAL INFORMATION: The COPD data reported herein were secondary data (Placebo arm only) obtained through the following Clinical Trial: "Effect of Aclidinium/Formoterol on Nighttime Lung Function and Morning Symptoms in Chronic Obstructive Pulmonary Disease" ( https://clinicaltrials.gov/ct2/show/NCT02429765 ; NCT02429765).
PURPOSE: To assess whether night-time increases in mechanical loading negatively impact respiratory muscle function in COPD and whether compensatory increases in inspiratory neural drive (IND) are adequate to stabilize ventilatory output and arterial oxygen saturation, especially during sleep when wakefulness drive is withdrawn. METHODS: 21 patients with moderate-to-severe COPD and 20 age-/sex-matched healthy controls (CTRL) participated in a prospective, cross-sectional, one-night study to assess the impact of COPD on serial awake, supine inspiratory capacity (IC) measurements and continuous dynamic respiratory muscle function (esophageal manometry) and IND (diaphragm electromyography, EMGdi) in supine sleep. RESULTS: Supine inspiratory effort and EMGdi were consistently twice as high in COPD versus CTRL (p < 0.05). Despite overnight increases in awake total airways resistance and dynamic lung hyperinflation in COPD (p < 0.05; not in CTRL), elevated awake EMGdi and respiratory effort were unaltered in COPD overnight. At sleep onset (non-rapid eye movement sleep, N2), EMGdi was decreased versus wakefulness in COPD (- 43 ± 36%; p < 0.05) while unaffected in CTRL (p = 0.11); however, respiratory effort and arterial oxygen saturation (SpO2) were unchanged. Similarly, in rapid eye movement (stage R), sleep EMGdi was decreased (- 38 ± 32%, p < 0.05) versus wakefulness in COPD, with preserved respiratory effort and minor (2%) reduction in SpO2. CONCLUSIONS: Despite progressive mechanical loading overnight and marked decreases in wakefulness drive, inspiratory effort and SpO2 were well maintained during sleep in COPD. Preserved high inspiratory effort during sleep, despite reduced EMGdi, suggests continued (or increased) efferent activation of extra-diaphragmatic muscles, even in stage R sleep. CLINICAL TRIAL INFORMATION: The COPD data reported herein were secondary data (Placebo arm only) obtained through the following Clinical Trial: "Effect of Aclidinium/Formoterol on Nighttime Lung Function and Morning Symptoms in Chronic Obstructive Pulmonary Disease" ( https://clinicaltrials.gov/ct2/show/NCT02429765 ; NCT02429765).
Authors: Nicolle J Domnik; Matthew D James; Robin E Scheeren; Grace A Ayoo; Sarah M Taylor; Amanda T Di Luch; Kathryn M Milne; Sandra G Vincent; Devin B Phillips; Amany F Elbehairy; Sophie J Crinion; Helen S Driver; J Alberto Neder; Denis E O'Donnell Journal: Chest Date: 2020-06-27 Impact factor: 9.410
Authors: J R Bennett; H M A Dunroy; D R Corfield; N Hart; A K Simonds; M I Polkey; M J Morrell Journal: Neurology Date: 2004-01-13 Impact factor: 9.910