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Clinical Investigations: SLEEP |

Nocturnal Efficiency and Tolerance of a Demand Oxygen Delivery System in COPD Patients With Nocturnal Hypoxemia*

Antoine Cuvelier, MD; Jean-François Muir, MD, FCCP; Pierre Czernichow, MD; Emmanuel Vavasseur, MD; Florence Portier, MD; Daniel Benhamou, MD; Dominique Samson-Dolfuss, MD
Author and Funding Information

*From the Respiratory and Intensive Care Department (Drs. Cuvelier, Muir, Vavasseur, Portier, and Benhamou), Epidemiology Department (Dr. Czernichow), and Neurology Department (Dr. Samson-Dolfuss), Rouen University Hospital, Rouen, France.

Correspondence to: Antoine Cuvelier, MD, Respiratory and Intensive Care Department, Rouen University Hospital, 76031 Rouen cedex, France; e-mail: a-cuvelier@webmails.com



Chest. 1999;116(1):22-29. doi:10.1378/chest.116.1.22
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Objectives: We compared the efficacy of the standard nasal cannula and the demand oxygen delivery system (DODS) during sleep in patients with COPD.

Subjects: Twenty patients with moderate or severe COPD were included in the study.

Methods: Four consecutive polysomnographic recordings were performed under the following conditions: DODS powered by compressed air (night 1 [N1]); oxygen delivered with a nasal cannula alone (night 2 [N2]); oxygen delivered through a DODS (night 3 [N3]); and oxygen delivered with nasal cannula alone (night 4 [N4]). Oxygen flow rates with and without DODS were adjusted the day before the first night so that the resulting transcutaneous arterial oxygen saturation (Sao2) was ≥ 95%. The following parameters were evaluated each night: apnea-hypopnea index, nocturnal Sao2, total oxygen saving, and several neurophysiologic parameters.

Results: The oxygen saving with the DODS was, on average, 60%. All parameters obtained during N2 and N4 (oxygen alone) were identical. The percentage of total recording time spent at Sao2 ≥ 95% was comparable between N2 ([mean ± SD]; 69 ± 32%) and N3 (61 ± 31%) (difference is not significant [NS]), as was the time spent at Sao2 between 90% and 95% (N2, 29.8 ± 31%; N3, 35.9 ± 27%; NS) and < 90% (N2, 0.75 ± 2.6%; N3, 2.5 ± 8.6%; NS). Although the mean response time was not significantly different between N2 and N3, two patients experienced a substantial increase in response time with an Sao2 < 90% on the DODS. The DODS device did not induce any difference in the percentage of time spent in rapid eye movement (REM) sleep (N2, 12.3 ± 8.7%; N3, 16.4 ± 7.8%; NS) or non-REM sleep (N2, 87.7 ± 8.7%; N3, 83.7 ± 7.9%; NS). Non-REM distribution in stage 1–2 sleep and in stage 3–4 sleep was comparable between N2 and N3. Similarly, no difference was observed for the sleep efficiency index (N2, 71 ± 15%; N3, 69.6 ± 14%; NS). Differences between sleep onset latency times were NS.

Conclusions: In a majority of moderate to severe COPD patients, the use of a DODS device does not induce any significant alteration of nocturnal neurophysiologic and ventilatory profiles. However, the presence of nocturnal desaturation in a few patients justifies the need to systematically perform a ventilatory polygraphic recording when prescribing a DODS device.

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