![]() The flowchart describing patient recruitment is shown in Fig. Written informed consent was obtained from all study participants. Patients were excluded from this study if they were receiving positive-pressure ventilation therapy, experienced exacerbation within one month, or had any type of cancer. The indication for HOT was based on the guideline of the Ministry of Health, Labor and Welfare (patients with severe chronic respiratory failure whose partial pressure of arterial oxygen was ≤55 mmHg or whose partial pressure of arterial oxygen was ≤60 mmHg and with significant hypoxemia during sleep and exercise). We enrolled 58 outpatients diagnosed with chronic respiratory disease who met the following criteria: age ≥20 years old receiving HOT for chronic respiratory failure stable condition of chronic respiratory disease and free from exacerbation for at least 1 month. The current study was conducted with the approval of the Ethics Committees or Institutional Review Board of Kobe University Hospital (1592). This multicentre prospective study was performed between August 2014 and March 2017 at six general hospitals in Japan: Kobe University Hospital, Takatsuki General Hospital, Municipal Kasai Hospital, Kakogawa Central City Hospital, Kitaharima Medical Center, and Akashi Medical Center. Given the above, the present study explored the diversity of nocturnal desaturation. We suspect this discrepancy may arise from the diversity of nocturnal desaturation. However, treatment for nocturnal desaturation does not always lead to improvement in the patient outcome ( 8). Therefore, nocturnal desaturation should be detected by proper screening and appropriate treatment, especially in patients with chronic respiratory disease. Nocturnal desaturation has an important clinical implication, as it is related to daytime respiratory failure, exacerbation frequency, a poor sleep quality, pulmonary hypertension, and mortality ( 3, 6, 7). Another study reported that 40% of patients receiving home oxygen therapy (HOT) have sleep-related oxygen desaturation ( 5). Indeed, several studies have reported that 27-70% of patients with chronic obstructive pulmonary disease (COPD) have sleep-related oxygen desaturation, although they do not have daytime oxygen desaturation ( 3). This reduction can be negligible in healthy subjects however, in patients with chronic respiratory diseases who have a poor respiratory function or who are highly dependent on accessory muscles of respiration, this reduction can lead to nocturnal desaturation. Even in healthy subjects, minute ventilation drops by approximately 15% from wakefulness to non-REM sleep and further to REM sleep ( 4). These changes lead to a decrease in minute ventilation, resulting in alveolar hypoventilation ( 2, 3), which is not fully compensated by increasing breathing frequency and ventilation from the diaphragm. ![]() During sleep, particularly REM sleep, the hypoxic and hypercapnic ventilatory responses of the respiratory centre are blunted, and the tone and activity of the respiratory muscles are diminished. Sleep is composed of three different stages: wakefulness, rapid eye movement (REM) sleep, and non-REM sleep. Sleep affects breathing in several ways, including through changes in the respiratory centre, respiratory muscle hypotonia, and lung mechanics. ![]() Nocturnal desaturation is a well-known complication in patients with chronic respiratory disease ( 1).
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