Sleep and respiration: Implications for pulmonary rehabilitation

Despite the growing interest in the role of the inspiratory and accessory muscles of respiration in chronic respiratory disease, few therapists have considered the role sleep may play in the deterioration of a patient's clinical condition. A number of important physiological changes to respiration occur during sleep, which affect chest wall mechanics and gas exchange. The ensuing abnormalities caused by sleep hypoventilation and fragmentation can severely affect daytime function and wellbeing. Nocturnal nasal positive pressure ventilation (NIPPV) is now established as an effective means of preventing such changes in patients with chest wall and lung disease. Therapists involved in pulmonary rehabilitation programs must recognise the potential for nocturnal respiratory events to severely affect daytime function and understand the importance of reversing nocturnal respiratory failure in order to maximise the rehabilitation potential of patients.