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Am Fam Physician. 1999;60(3):940

Sleep disturbance is common in patients with chronic obstructive pulmonary disease (COPD). In recent studies, patients with COPD had more problems initiating and maintaining sleep than patients without this disease. They also reported a significant amount of daytime sleepiness. The other concern about patients with COPD and sleep problems is the incidence of decreased arterial oxygen saturation in this group. Martin and colleagues evaluated the effect of ipratropium bromide solution on the quality of sleep, nocturnal oxygen saturation and lung function in a four-week, randomized, double-blinded, placebo-controlled study of patients with moderate to severe COPD.

Patients with COPD who had a forced expiratory volume in one second (FEV1) of less than 65 percent of predicted value were enrolled in the study. Patients were randomized to receive ipratropium or placebo. Both groups received nebulizer treatment at bedtime. Sleep studies were performed before treatment and three times during the treatment phase. Sleep quality as perceived by the patient was also recorded. To determine compliance, a 24-hour urine sample for ipratropium was performed at the end of the study.

Treatment with ipratropium improved the total time spent in REM sleep as well as total sleep time. Awakenings and arousals per hour decreased in the ipratropium group but not significantly. Arterial oxygen saturation levels were better in the ipratropium treatment group. Patients in the ipratropium group had a significantly better perception of their sleep quality than patients in the placebo group. The compliance rate in the ipratropium group was 85 percent, based on the urine studies.

Quality of sleep can be significantly compromised in patients with COPD. They tend to have decreased total sleep time, more arousals and generally poor sleep. This can have a significant impact on quality of life. Ipratropium at bedtime can improve the quality of sleep in these patients. It can also improve nighttime arterial oxygen saturation levels. The latter may assist in reducing the incidence and severity of pulmonary hypertension. The authors conclude that ipratropium treatment at bedtime can improve the quality of sleep in patients with COPD as well as their arterial oxygen saturation levels. These improvements could lead to an overall improvement in quality of life.

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