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NOD is a common event in patients with symptomatic COPD who are not hypoxemic while awake. Up to 45% of these patients may have significant oxyhemoglobin desaturation during sleep, and most have evidence of pulmonary arterial hypertension. Although intuitively it would seem that supplemental oxygen during sleep should be of medical benefit in COPD patients with NOD, studies to data have not substantiated this idea. Medicare requirements for prescribing nocturnal oxygen are relatively liberal and there is the possibility of misuse, which would cause a substantial increase in the cost of home health care. A well designed multicenter study is needed to provide appropriate indications and guidelines for therapy in these patients.

These guidelines were developed by the American Association for Respiratory Care in response to a request by the Health Care Financing Administration for professional assistance in defining criteria for establishment of demonstration units for management of chronic ventilator-dependent patients in hospitals. Although the exact method by which these demonstration units (3 to 5 in number) will be selected has not been announced, these guidelines will have an important role in assuring that appropriate sites are chosen and that patient selection and data collection are adequate to document the possible benefits of such units.