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7?��?8.3%). In multivariate analysis, daytime PaO2 correlated independently with sleep efficiency (P?=?0.041), whereas FEV1 positively correlated with arousal index, and age correlated negatively with rapid eye movement sleep duration. Conclusions:? Sleep quality is poor in patients with severe COPD compared with normative populations of similar age, and daytime hypoxaemia is independently associated with impaired sleep efficiency. Chronic selleck chemical obstructive pulmonary disease (COPD) is the fourth leading cause of chronic morbidity and mortality in the United States and is projected to rank fifth by 2020 in the burden of disease worldwide.1 Sleep-induced hypoxaemia and hypercapnia in COPD can result in cardiac arrhythmias and pulmonary hypertension,2,3 and nocturnal deaths may result during exacerbations.4 The physiological hypoventilation that accompanies normal sleep is the principal reason for worsening gas exchange abnormalities and is most significant in patients who are hypoxaemic while awake because of their precarious position at, or close to, the steep portion of the oxyhaemoglobin dissociation curve.5 These abnormalities are separate and distinct from obstructive sleep apnoea syndrome.6 Poor sleep quality in COPD has been suggested by various studies. In a large multicentre survey, about 40% of COPD patients reported limited sleep.7 A few studies have employed polysomnography (PSG) in COPD patients, and reduced sleep time, disturbed sleep architecture and increased arousals have been observed,8�C10 but these particular studies involved small patient numbers. Valipour DDR1 et?al. performed a case�Ccontrol study including 104 subjects and found a significantly reduced sleep time, sleep efficiency and rapid eye movement sleep in COPD patients versus controls.11 Sanders and co-workers12 analysed PSG and spirometry data on 1138 community-based patients from the Sleep Heart Health Study with mild airflow obstruction (forced expiratory volume in 1?s (FEV1)/forced vital capacity ratio Veliparib datasheet airflow obstruction was mild (mean FEV1/forced vital capacity ratio 64%). Therefore, controversy exists about the quality of sleep in COPD. Furthermore, the mechanisms leading to impaired sleep quality in COPD are poorly understood. A recent study by Krachman et?al. demonstrated that airflow obstruction and hyperinflation correlated with sleep quality in 25 subjects with severe emphysema and also reported that oxygen saturation (SaO2) contributed in a prediction model of sleep quality.