Dr. Amy Attaway and Dr. Dan Culver review the emerging relationship between COPD patients who have intermittent hypoxemia and an increase they have in co-morbidities and mortality. They discuss how multiple associative studies suggest that intermittent hypoxemia may impact musculature, cardiovascular and neurologic systems. Dr. Attaway and Dr. Culver also underscore the need to review studies in light of the impact of skin pigmentation on oximetry, the connection to Sarcopenia and a related shift in muscle fibers from Type 1 to Type 2.