Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a global health issue affecting not only the respiratory system but also the autonomic nervous system. The complex interaction between COPD severity, chronic hypoxemia, and autonomic neuropathy is vital to understanding and managing the disease. Hypoxemia in COPD, characterized by reduced oxygen levels, is correlated with increased sympathetic activity and alterations in heart rate variability. Aim: The study aims to explore the relationship between COPD severity, hypoxemia, and autonomic neuropathy to improve diagnostic and therapeutic strategies. Material and Methods: A detailed study was conducted on 39 participants with COPD at a tertiary care centre over 18 months. The cardiovascular autonomic function was assessed through various tests, including heart rate response during deep breathing, blood pressure monitoring during isometric handgrip exercises, and orthostatic and Valsalva manoeuvre tests. The participants' lung function and hypoxemia were also evaluated. Results: The participants, predominantly male, exhibited a resting heart rate of 83.64±6.13 bpm, and systolic and diastolic blood pressure of 126.62±4.84 mm Hg and 83.28±3.45 mm Hg respectively. Autonomic function tests varied significantly with COPD severity. Significant correlations were found between FEV1, SpO2 and various autonomic function tests. In particular, decreased FEV1 and SpO2 levels were associated with altered blood pressure and heart rate responses during orthostatic and Valsalva manoeuvre tests. Conclusion: The findings emphasize the importance of assessing cardiovascular and pulmonary parameters to understand the autonomic responses in COPD patients. Correlations between FEV1, SpO2, and autonomic function tests highlight the complex interplay between lung function, oxygen saturation, and autonomic responses. This insight can contribute to the development of targeted therapeutic and management strategies for COPD patients with autonomic dysfunction.