The Study Of Factors Of Nocturnal Desaturation And Effects To Salmeterol/Fluticasone In Patients With Chronic Obstructive Pulmonary Disease

Objectives: Nocturnal hypoxia occurs commonly in patients with chronic obstructive pulmonary disease(COPD) which is associated with a poor prognosis. This study was to identify factors which might predict nocturnal desaturation in COPD patients. Salmeterol/fluticasone includes a long-acting β₂-adrenergic agonist and a glucocorticoid. This trial was designed to investigate the effects of inhaled salmeterol/fluticasone on nocturnal hypoxia and sleep quality, and to deduce the possible mechanism. The same time, this study evaluated the endothelin(ET)-l blood levels in nocturnal oxygen desaturators(NOD) before and after salmeterol/fluticasone and none-nocturnal oxygen desaturators(N-NOD). Methods: We admitted 80 stable COPD patients. All Patients underwent overnight polysomnography (PSG) to exclude OS AS and T90≥5% was NOD, if not, was N-NOD. Every one took pulmonary function (FEV₁, FEV₁/FVC, PEF), respiratory drive(mouth occlusion pressure 100 milliseconds after initiation of breath, P_0.1), functions of repiratory muscle(maximal inspiratory pressure, PImax; maximal expiratory pressure, PEmax), arterial blood gases(PaO₂, SaO₂, PaCO₂), plasma endothelin-1(ET-1) and Borg's scale score examinations before and after the 6-minute walking test. In this double-blind, parallel, placebo-controlled study, on the basis of routine therapy, 20 patients with NOD received 50/250 μ g salmeterol/fluticasone twice a day for 4 weeks. Others maintained routine therapy. We evaluated above items before and after therapy.Results: (1)35 patients (43.75%) experienced nocturnal oxygen desaturation. Desaturators had lower awake PaO₂, SaO₂, FEV₁, FEV₁/FVC, PEF and 6-minute walking distance, but higher awake PaCO₂, resistance of airway on 4Hz or 8Hz(R4Hz, R8Hz) than that of non-desaturators. There was negative correlation between T90 and FEV₁, PEF, PaO₂, SaO₂, et al and positive correlation between T90 and PaCO₂, R4Hz, R8Hz, waistline. (2)The predictive formula was:...