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Clinical Investigations: SLEEP AND BREATHING |

Effect of Ipratropium Bromide Treatment on Oxygen Saturation and Sleep Quality in COPD*

Richard J. Martin, MD, FCCP; Becki L. Bucher Bartelson, PhD; Philip Smith, MD; David W. Hudgel, MD, FCCP; David Lewis, MD, FCCP; Gerhardt Pohl, PhD; Paul Koker, MS; Joseph F. Souhrada, MD, PhD
Author and Funding Information

*From the National Jewish Medical and Research Center (Drs. Martin and Bartelson), Denver, CO; Johns Hopkins Asthma and Allergy Center (Dr. Smith), Baltimore, MD; MetroHealth Medical Center (Dr. Hudgel), Cleveland, OH; Harbor UCLA Medical Center (Dr. Lewis), Torrance, CA; and Boehringer Ingelheim Pharmaceuticals Inc (Drs. Pohl and Souhrada and Mr. Koker), Ridgefield, CT. Supported by a grant from Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT.

Correspondence to: Richard J. Martin, MD, FCCP, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206; e-mail: martinr@njc.org



Chest. 1999;115(5):1338-1345. doi:10.1378/chest.115.5.1338
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Study objectives: Patients with COPD are at risk of experiencing a deterioration in arterial oxygen saturation (Sao2) during sleep, which is generally most pronounced during rapid eye movement (REM) sleep. Increased cholinergic tone has been suggested as a contributing factor to this decrease in Sao2. Therefore, we investigated whether 4-week treatment with ipratropium bromide inhalation solution 0.02% (qid) could improve sleep characteristics in COPD.

Design: Randomized, placebo-controlled, double-blind, two-arm parallel study of 4 weeks of treatment with ipratropium bromide solution or placebo.

Setting: Multicenter investigation.

Patients: Thirty-six patients with moderate-to-severe COPD (FEV1 < 65% of predicted).

Measurements and results: Evaluation included polysomnographic, pulmonary function, and subjective quality of sleep (visual analog scale [VAS]) assessments. It was found that 4 week of treatment with ipratropium bromide solution in patients with COPD led to the following: (1) a significant (p = 0.05) improvement in mean nocturnal Sao2 with the more severe the nocturnal desaturation, the greater the improvement in Sao2; (2) significant (p = 0.03) improvement in perceived sleep quality (VAS: 5.5 ± 0.5 after placebo; 7.2 ± 0.5 after ipratropium); (3) a significant (p = 0.05) increase in REM sleep time (48.6 ± 6.3 min after placebo; 66.5 ± 6.4 min after ipratropium) with no effect on other sleep stages or total sleep time; and (4) a significant (p = 0.01) increase in pre-sleep FVC and flow rate at 50% of the vital capacity.

Conclusions: These findings demonstrate that ipratropium bromide therapy can improve sleep Sao2 as well as sleep quality in patients with moderate-to-severe COPD.

Abbreviations: ANCOVA = analysis of covariance; IB = ipratropium bromide; REM = rapid eye movement; Sao2 = arterial oxygen saturation; TST = total sleep time; VAS = visual analog scale

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