Sleep and Mechanical Ventilation in Stable COPD Patients

Respiratory work is physiologically increased during sleep and leads to severe alterations in COPD patients, especially by raising sleep hypoventilation. The diurnal impact of these nocturnal events may have been underestimated in COPD patients. Impaired sleep and the increase of respiratory work may be one of the major trigger of diurnal events like hypoventilation, exacerbation and even mortality. One of the most commonly used nocturnal treatments at the present time is noninvasive ventilation (NIV). However, there is an on-going debate concerning the indications and objectives of NIV in COPD patients. In most studies, NIV initiation and monitoring depend on diurnal tools like PaCO2, and the nocturnal efficacy of this treatment has not yet been adequately determined. In other respiratory diseases, sleep events have a predominant role in NIV therapy. Such nocturnal events drive NIV initiation and setting adaptation. Monitoring of sleep events is associated with an increase in health related to quality of life and a decrease in mortality. The monitoring may be the solution to solve the debate of NIV in COPD patients. This article reviews the impact of sleep in COPD patients and the value of long-term NIV.