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01-03-2022 | Formoterol | Original Article

Compensatory responses to increased mechanical abnormalities in COPD during sleep

Authors: Nicolle J. Domnik, Devin B. Phillips, Matthew D. James, Grace A. Ayoo, Sarah M. Taylor, Robin E. Scheeren, Amanda T. Di Luch, Kathryn M. Milne, Sandra G. Vincent, Amany F. Elbehairy, Sophie J. Crinion, Helen S. Driver, J. Alberto Neder, Denis E. O’Donnell

Published in: European Journal of Applied Physiology | Issue 3/2022

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to stabilize ventilatory output and arterial oxygen saturation, especially during sleep when wakefulness drive is withdrawn.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).

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Title: Compensatory responses to increased mechanical abnormalities in COPD during sleep
Authors: Nicolle J. Domnik
Devin B. Phillips
Matthew D. James
Grace A. Ayoo
Sarah M. Taylor
Robin E. Scheeren
Amanda T. Di Luch
Kathryn M. Milne
Sandra G. Vincent
Amany F. Elbehairy
Sophie J. Crinion
Helen S. Driver
J. Alberto Neder
Denis E. O’Donnell
Publication date: 01-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Formoterol
Aclidinium
Chronic Obstructive Lung Disease
Published in: European Journal of Applied Physiology / Issue 3/2022
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI: https://doi.org/10.1007/s00421-021-04869-0

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Springer Medicine

Compensatory responses to increased mechanical abnormalities in COPD during sleep

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial information

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial information

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