Elsevier

Clinics in Chest Medicine

Volume 35, Issue 3, September 2014, Pages 505-512
Clinics in Chest Medicine

Sleep in Patients with Restrictive Lung Disease

https://doi.org/10.1016/j.ccm.2014.06.006Get rights and content

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Key points

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    Restrictive lung disease is associated with nocturnal pathophysiology, including sleep disturbances and breathing and oxygenation impairments during sleep.

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    Sleep is disrupted because of changes in sleep architecture and comorbid sleep disorders.

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    Sleep changes in restrictive lung diseases affect sleep quality and contribute to daytime fatigue in this population.

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    Little is known about the impact of treatment of sleep disorders and sleep disruption on sleep quality and daytime complaints in

Interstitial lung disease

Fatigue is a common complaint among patients with ILD. Sleep is disrupted due to respiratory pathophysiology such as nocturnal hypoxemia, changes in sleep architecture, and comorbid sleep disorders. These sleep changes in ILD affect sleep quality and contribute to daytime fatigue in this population.

Musculoskeletal thoracic disease

Severe chest wall deformity may lead to a restrictive ventilatory defect with reduced total lung capacity, vital capacity, and functional residual capacity. These patients may have hypoxemia, hypercapnia, pulmonary hypertension, cor pulmonale, and chronic respiratory failure. Thoracic cage deformity alters chest wall mechanics and produces ineffective respiratory muscle mechanics. As a result, these patients may have increased work of breathing, diminished strength and endurance, and increased

Neuromuscular disease

Respiratory muscle weakness may lead to significant restrictive ventilatory defect, hypoventilation, and respiratory failure. Many patients with neuromuscular disease die of respiratory failure due to severe diaphragmatic weakness or abnormalities in respiratory control. In normal subjects, during sleep upper airway resistance increases, chemosensitivity is reduced, and the wakefulness drive to breathe is lost, resulting in a slight reduction in ventilation. During REM sleep, ribcage and

Obesity hypoventilation

OHS is defined by the clinical triad of obesity, daytime hypoventilation, and SDB. The mechanism by which obesity leads to hypoventilation is complex and not fully understood. Several mechanisms have been proposed in the pathogenesis of OHS, including abnormal respiratory system mechanics due to obesity, impaired central responses to hypercapnia and hypoxemia, SDB, and neurohormonal abnormalities.

SDB takes 2 forms in OHS. The most common form is OSA and occurs in the vast majority of patients

Summary

Patients with restrictive lung disease exhibit a wide range of sleep-related abnormalities, including breathing, movement, architecture, and circadian disorders. There are many unanswered questions regarding the role of sleep and the impact of sleep disorders and their treatment on intrapulmonary and extrapulmonary restrictive ventilatory disorders.

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