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