Cynthia Brown, MD

American Lung Association Scholar: Breathing Mechanics, Control of Breathing, and Sleep Disordered Breathing

A survey by the American Lung Association revealed that half of all COPD patients say their condition limits their ability to sleep. But the reason that COPD affects sleep is unknown. Cynthia Brown, MD, says it is frustrating not to be able to offer her COPD patients an effective solution to their sleep difficulties.

With help from an American Lung Association Clinical Patient Care Research Grant, Dr. Brown is investigating the reasons for the problem, as well as a potential treatment.

"The patients we have studied tend to have a lot of awakenings at night, but it's not necessarily related to low oxygen levels caused by COPD, or to sleep apnea," she says.

Previously, Dr. Brown studied the impact of sleep problems in patients with COPD. "Sleep symptoms have a strong negative impact on their quality of life," she says. "It affects their energy levels, and how much they're able to do." Physicians often don't ask their COPD patients about their sleep, and even if they do, they don't have much to offer them to solve the problem, she says. While some doctors prescribe oxygen or continuous positive airway pressure (CPAP), the most common treatment for sleep apnea, neither of these treatments has been shown to have great benefit in improving the sleep problems of COPD patients unless they also have underlying sleep apnea, Dr. Brown says.

In her American Lung Association-supported study, patients with COPD stay overnight in a sleep lab, so researchers can observe their sleep patterns in an attempt to better understand the physiologic mechanisms of sleep disturbances in COPD.

Dr. Brown is also testing a new device called transnasal insufflation, a nasal tube that delivers warm, humidified air at a high flow rate while the person sleeps. Preliminary evidence suggests that this device can improve breathing during sleep in COPD by applying a small amount of air pressure to the back of the throat during sleep to minimize difficulty with inhaling.

Transnasal insufflation is also being studied elsewhere as a possible treatment for sleep apnea. It is currently approved as a treatment for sleep apnea in Europe, but not in the United States.

The next step in Dr. Brown's research after the sleep lab studies are completed will be to test nasal insufflation in a home setting.

"This research wouldn't be possible without the American Lung Association grant," she says. "Sleep research is expensive, so this grant is invaluable."