Sleep disorders in chronic obstructive pulmonary disease

Sleep disorders in chronic obstructive pulmonary disease (COPD) can occur in 60–70% of patients. They have adverse outcome in terms of both morbidity and mortality of COPD. The various sleep disorders seen in COPD are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), nocturnal hypoventilation, and nocturnal oxygen desaturation (NOD). Of these disorders, insomnia and RLS can be diagnosed on history. OSA, sleep hypoventilation, and NODmay require type I polysomnography with/without transcutaneous or exhaled CO2 monitoring. Management consists of either conservative management or drug therapy for insomnia and RLS. If pharmacotherapy is required, ramelteon for insomnia and dopaminergic drug for RLS may be given. Treatment of OSA is continuous positive airway pressure, which relieves both OSA and COPD. Nocturnal hypoventilation usually requires oxygen along with noninvasive ventilator. Treatment of only NOD is controversial, but nocturnal oxygen may be given after ruling out nocturnal hypoventilation. This review emphasises the need of sleep disorders evaluation for comprehensive management of COPD.