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Resumen
Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) presentan un sueño que, globalmente, es de inferior calidad que el de los individuos sanos. La hipoventilación durante el sueño es la causa más importante de hipoxemia y es probable que la presencia de alteraciones de la ventilación/perfusión y una reducción de la capacidad residual funcional también contribuyan de forma significativa. Aunque parece razonable suponer que los episodios de desaturación nocturna podrían aumentar la morbimortalidad de estos pacientes, no se ha probado la trascendencia pronóstica de estas desaturaciones. Sin embargo, es muy importante detectar a los pacientes con EPOC en quienes se añade un síndrome de apnea-hipopnea del sueño (SAHS), porque se ha demostrado que la morbimortalidad es superior a la que presentarían estas entidades por separado. La polisomnografía sólo está indicada ante la sospecha de la asociación de una EPOC y un SAHS. No obstante, hay pacientes en quienes puede ser necesario conocer el comportamiento respiratorio durante el sueño y en quienes pueden ser útil técnicas como la pulsioxímetría, la capnografía y/o poligrafía respiratoria, y, si fuera necesario, indicar posteriormente una polisomnografía.
Aún precisamos más estudios que nos ayuden a comprender mejor las alteraciones fisiopatológicas de estos pacientes durante el sueño, la trascendencia de las desaturaciones nocturnas y el papel de la oxigenoterapia y del apoyo ventilatorio, así como la importancia de algunos fármacos que permitan mejorar la calidad de sueño y el intercambio de gases en estos pacientes.
Palabras clave:
Síndrome de apnea-hipopnea del sueño
Enfermedad pulmonar obstructiva crónica
Síndrome de overlap
Abstract
Sleep quality is lower in patients with chronic obstructive pulmonary disease (COPD) than in healthy individuals. Hypoventilation during sleep is the most important cause of hypoxemia and the presence of ventilation/perfusion alterations and reduced functional residual capacity probably also plays a significant role. Although episodes of nocturnal saturation can reasonably be supposed to increase morbidity and mortality in these patients, the diagnostic importance of these desaturations has not been demonstrated. However, desaturation episodes must be detected in patients with COPD and sleep apnea-hypopnea syndrome (SAHS), since morbidity and mortality are higher when these two entities are combined than when they occur separately.
Polysomnography is only indicated when the association of COPD and SAHS is suspected. Nevertheless, in some patients, respiratory behavior during sleep must be evaluated and techniques such as pulse oximetry, capnography and/or respiratory polygraphy and, if necessary, subsequent polysomnography may be useful. Further studies are required to elucidate the role of physiopathological alterations during sleep, the importance of nocturnal desaturations and the role of oxygen therapy and ventilatory support, as well as the utility of some drugs that could improve sleep quality and gas exchange in these patients.
Keywords:
Sleep apnea-hypopnea syndrome
Chronic obstructive pulmonary disease
Overlap syndrome
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