Supine hyperinflation and expiratory flow limitation are associated with respiratory arousals and nocturnal hypoventilation in COPD.

Srinivasan, M; Touma, D; Blokland, KEC; Patel, K; Tonga, KO; Chapman, DG; Chan, ASL; Cistulli, PA; King, GG

Supine hyperinflation and expiratory flow limitation are associated with respiratory arousals and nocturnal hypoventilation in COPD.

Srinivasan, M Touma, D Blokland, KEC Patel, K Tonga, KO Chapman, DG Chan, ASL Cistulli, PA King, GG

Permalink

Publisher:: BMJ
Publication Type:: Journal Article
Citation:: BMJ Open Respir Res, 2025, 12, (1), pp. e003513
Issue Date:: 2025-11-05

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Accepted versionAdobe PDF (790.1 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Srinivasan, M
dc.contributor.author	Touma, D
dc.contributor.author	Blokland, KEC
dc.contributor.author	Patel, K
dc.contributor.author	Tonga, KO
dc.contributor.author	Chapman, DG
dc.contributor.author	Chan, ASL
dc.contributor.author	Cistulli, PA
dc.contributor.author	King, GG
dc.date.accessioned	2026-01-16T04:11:31Z
dc.date.available	2025-09-30
dc.date.available	2026-01-16T04:11:31Z
dc.date.issued	2025-11-05
dc.identifier.citation	BMJ Open Respir Res, 2025, 12, (1), pp. e003513
dc.identifier.issn	2052-4439
dc.identifier.issn	2052-4439
dc.identifier.uri	http://hdl.handle.net/10453/191907
dc.description.abstract	INTRODUCTION: Subjective sleep disturbance is common in chronic obstructive pulmonary disease (COPD) and is related to hyperinflation when supine and tidal expiratory flow limitation (EFL). We hypothesised that abnormalities in supine lung mechanics disturb sleep and impair gas exchange in COPD. We aimed to assess relationships between supine lung derecruitment, EFL and hyperinflation, and polysomnographic measures of sleep disturbance and gas exchange in COPD. METHODS: In this prospective, observational study, supine oscillometry was performed in stable COPD patients to assess lung derecruitment (reactance at 5 Hz (Xrs5) z-score) and EFL (difference between mean inspiratory and expiratory reactance (∆Xrs5)). Hyperinflation was assessed by supine inspiratory capacity (ICsupine) z-score. In-laboratory polysomnography was used to assess sleep disturbance, measured by Apnoea-Hypopnoea Index (AHI), Oxygen Desaturation Index (ODI) and AHI during rapid eye movement sleep (AHI REM). Monitoring of transcutaneous carbon dioxide (TcCO2), and measurements of partial pressure of arterial carbon dioxide (PaCO2) and HCO3 - were performed in a subgroup. RESULTS: 28 COPD patients were enrolled (13 female, mean age (SD) 67.5 (8.71) years and mean forced expiratory volume in 1second (FEV1) z-scores (SD) -2.61 (1.06)). Worse Xrs5(supine) correlated with greater respiratory arousals (AHI rs =0.47, p=0.01; ODI rs=-0.58, p=0.001), as did greater ∆Xrs5(supine) (AHI REM rs=0.53, p=0.005). Xrs5(supine) correlated with peripheral oxygen saturation nadir (rs=0.43, p=0.02). ICsupine correlated negatively with hypoventilation (PaCO2 rs=-0.77, p=0.001; HCO3 - rs=-0.78, p=0.001, n=15), as did Xrs5(supine) (rise in TcCO2 rs=-0.65, p=0.009). CONCLUSION: Lung derecruitment, EFL and supine hyperinflation likely contribute to sleep disturbance and sleep-related gas exchange impairment in COPD.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ
dc.relation.ispartof	BMJ Open Respir Res
dc.relation.isbasedon	10.1136/bmjresp-2025-003513
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	3201 Cardiovascular medicine and haematology
dc.subject.classification	3202 Clinical sciences
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Female
dc.subject.mesh	Aged
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Middle Aged
dc.subject.mesh	Polysomnography
dc.subject.mesh	Hypoventilation
dc.subject.mesh	Supine Position
dc.subject.mesh	Arousal
dc.subject.mesh	Pulmonary Gas Exchange
dc.subject.mesh	Exhalation
dc.subject.mesh	Inspiratory Capacity
dc.subject.mesh	Respiratory Mechanics
dc.subject.mesh	Humans
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Hypoventilation
dc.subject.mesh	Inspiratory Capacity
dc.subject.mesh	Pulmonary Gas Exchange
dc.subject.mesh	Polysomnography
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Arousal
dc.subject.mesh	Respiratory Mechanics
dc.subject.mesh	Exhalation
dc.subject.mesh	Supine Position
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Female
dc.subject.mesh	Aged
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Middle Aged
dc.subject.mesh	Polysomnography
dc.subject.mesh	Hypoventilation
dc.subject.mesh	Supine Position
dc.subject.mesh	Arousal
dc.subject.mesh	Pulmonary Gas Exchange
dc.subject.mesh	Exhalation
dc.subject.mesh	Inspiratory Capacity
dc.subject.mesh	Respiratory Mechanics
dc.title	Supine hyperinflation and expiratory flow limitation are associated with respiratory arousals and nocturnal hypoventilation in COPD.
dc.type	Journal Article
utslib.citation.volume	12
utslib.location.activity	England
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Science
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2026-01-16T04:11:29Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	12
utslib.citation.issue	1

Abstract:

INTRODUCTION: Subjective sleep disturbance is common in chronic obstructive pulmonary disease (COPD) and is related to hyperinflation when supine and tidal expiratory flow limitation (EFL). We hypothesised that abnormalities in supine lung mechanics disturb sleep and impair gas exchange in COPD. We aimed to assess relationships between supine lung derecruitment, EFL and hyperinflation, and polysomnographic measures of sleep disturbance and gas exchange in COPD. METHODS: In this prospective, observational study, supine oscillometry was performed in stable COPD patients to assess lung derecruitment (reactance at 5 Hz (Xrs5) z-score) and EFL (difference between mean inspiratory and expiratory reactance (∆Xrs5)). Hyperinflation was assessed by supine inspiratory capacity (ICsupine) z-score. In-laboratory polysomnography was used to assess sleep disturbance, measured by Apnoea-Hypopnoea Index (AHI), Oxygen Desaturation Index (ODI) and AHI during rapid eye movement sleep (AHI REM). Monitoring of transcutaneous carbon dioxide (TcCO2), and measurements of partial pressure of arterial carbon dioxide (PaCO2) and HCO3 - were performed in a subgroup. RESULTS: 28 COPD patients were enrolled (13 female, mean age (SD) 67.5 (8.71) years and mean forced expiratory volume in 1second (FEV1) z-scores (SD) -2.61 (1.06)). Worse Xrs5(supine) correlated with greater respiratory arousals (AHI rs =0.47, p=0.01; ODI rs=-0.58, p=0.001), as did greater ∆Xrs5(supine) (AHI REM rs=0.53, p=0.005). Xrs5(supine) correlated with peripheral oxygen saturation nadir (rs=0.43, p=0.02). ICsupine correlated negatively with hypoventilation (PaCO2 rs=-0.77, p=0.001; HCO3 - rs=-0.78, p=0.001, n=15), as did Xrs5(supine) (rise in TcCO2 rs=-0.65, p=0.009). CONCLUSION: Lung derecruitment, EFL and supine hyperinflation likely contribute to sleep disturbance and sleep-related gas exchange impairment in COPD.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/191907