Both hypoxemia and hypercapnia can develop during sleep in patients with chronic obstructive pulmonary disease. Respiratory impairment is more severe during REM sleep compared with NREM sleep. Hypoxemia, the extent of which is related to the percentage of REM sleep in relation to total sleep time and daytime levels of PaCO2, PaO2, and oxygen saturation [...]
Patients with nocturnal asthma often present with repetitive arousals and awakenings during the night accompanied by complaints of breathlessness, coughing, and wheezing secondary to bronchocontriction.25 A variety of factors may contribute to the worsening bronchoreactivity that occurs during sleep, including a relative increase in parasympathetic tone and decrease in nonadrenergic, noncholinergic discharge; comorbid gastroesophageal reflux [...]
Almitrine is a respiratory stimulant that enhances peripheral chemoreceptor sensitivity. Although it can potentially improve nighttime oxygenation, this effect is generally mild and inconsistent. Acetazolamide administration induces metabolic acidosis from bicarbonate diuresis; this, in turn, can stimulate respiration. Although it is beneficial for the treatment of high altitude–related periodic breathing, its usefulness for patients with [...]
Alcohol, when ingested while awake, can lead to reduction of both hypoxic and hypercapnic ventilatory responses. Irregular breathing with transient apneas can develop. When ingested close to bedtime, it depresses the upper airway muscle tone and may precipitate or aggravate a pre-existing obstructive sleep apnea; the latter is generally most evident during the first 1 [...]
Regulation of respiration differs significantly between sleep and wakefulness. With sleep onset, there occur important changes in the various processes that regulate respiratory control. Behavioral influences on respiration terminate with cessation of input from the waking state. Positional changes typically associated with sleep also result in significant alterations in respiratory mechanics. Finally, sleep is a [...]