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Short- and long-term effects of nocturnal oxygen therapy on sleep apnea in chronic heart failure

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Abstract

Purpose

This paper studies the short- and long-term effects of nocturnal oxygen therapy (NOT) on sleep apnea in chronic heart failure (CHF).

Methods

We enrolled 51 adults in New York Heart Association (NYHA) heart failure functional classes II or III, ≤45 % left ventricular ejection fraction (LVEF), in a randomized, open, single-center study. Nocturnal cardiorespiratory polygraphy showed sleep apnea [apnea-hypopnea index (AHI) ≥15 events/h] in 33 patients, of whom 19 were randomly assigned to NOT, 3.0 l/min, and 14 to no NOT. The NOT group underwent follow-up polygraphy at 24 h and 6 months, and the no NOT group a single follow-up polygraphy at 6 months.

Results

No significant difference was observed between baseline and 6 months in the no NOT group. In the NOT group, AHI decreased from 36.8 ± 2.6 events/h at baseline to 20.8 ± 3.0 at 24 h and to 18.3 ± 2.4 at 6 months (both P < 0.0001 vs. baseline), due to central AHI changes from 23.3 ± 2.8 events/h at baseline to 8.3 ± 1.6 at 24 h and to 6.1 ± 1.4 at 6 months (both P < 0.0001 vs. baseline). Oxygen desaturation index (ODI) decreased from 33.0 ± 5.2 events/h at baseline to 7.5 ± 0.5 at 24 h and 9.3 ± 2.6 at 6 months (both P < 0.0001 vs. baseline). NOT had no significant effect on obstructive and mixed AHI, quality of life (QOL), NYHA class, and LVEF up to 6 months of follow-up.

Conclusions

NOT decreased central AHI and ODI significantly within 24 h and up to 6 months in CHF patients with sleep apnea, without significantly modifying obstructive and mixed AHI, QOL, and ventricular function.

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Abbreviations

AHI:

Apnea-hypopnea index

ASV:

Adaptative servoventilation

CHF:

Chronic heart failure

CPAP:

Continuous positive airway pressure

CSA/CSR:

Central sleep apnea/Cheyne-Stokes respiration

LVEF:

Left ventricular ejection fraction

NOT:

Nocturnal oxygen therapy

NYHA:

New York Heart Association

ODI:

Oxygen desaturation index

QOL:

Quality of life

SaO2 :

Arterial oxyhemoglobin saturation

References

  1. Vazir A, Hastings PC, Dayer M, McIntyre HF, Henein MY, Poole-Wilson PA, Cowie MR, Morrell MJ, Simonds AK (2007) A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 9:243–250

    Article  CAS  PubMed  Google Scholar 

  2. Jilek C, Krenn M, Sebah D, Obermeier R, Braune A, Kehl V, Schroll S, Montalvan S, Riegger GA, Pfeifer M, Arzt M (2011) Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 13:68–75

    Article  PubMed  Google Scholar 

  3. Damy T, Margarit L, Noroc A, Bodez D, Guendouz S, Boyer L, Drouot X, Lamine A, Paulino A, Rappeneau S, Stoica MH, Dubois-Randé JL, Adnot S, Hittinger L, d’Ortho MP (2012) Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 14:1009–1019

    Article  PubMed  Google Scholar 

  4. Bradley TD, Logan AG, Kimoff RJ, Sériès F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Tomlinson G, Floras JS (2005) Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 353:2025–2033

    Article  CAS  PubMed  Google Scholar 

  5. Lüthje L, Renner B, Kessels R, Vollmann D, Raupach T, Gerritse B, Tasci S, Schwab JO, Zabel M, Zenker D, Schott P, Hasenfuss G, Unterberg-Buchwald C, Andreas S (2009) Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea. Eur J Heart Fail 11:273–280

    Article  PubMed Central  PubMed  Google Scholar 

  6. Tamisier R, Gilmartin GS, Launois SH, Pépin JL, Nespoulet H, Thomas R, Lévy P, Weiss JW (2009) A new model of chronic intermittent hypoxia in humans: effect on ventilation, sleep, and blood pressure. J Appl Physiol 107:17–24

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH (1989) The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med 111:777–782

    Article  CAS  PubMed  Google Scholar 

  8. Walsh JT, Andrews R, Starling R, Cowley AJ, Johnston ID, Kinnear WJ (1995) Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. Br Heart J 73:237–241

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Franklin KA, Eriksson P, Sahlin C, Lundgren R (1997) Reversal of central sleep apnea with oxygen. Chest 111:163–169

    Article  CAS  PubMed  Google Scholar 

  10. Javaheri S, Ahmed M, Parker TJ, Brown CR (1999) Effects of nasal O2 on sleep-related disordered breathing in ambulatory patients with stable heart failure. Sleep 22:1101–1106

    CAS  PubMed  Google Scholar 

  11. Krachman SL, D’Alonzo GE, Berger TJ, Eisen HJ (1999) Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration during sleep in congestive heart failure. Chest 116:1550–1557

    Article  CAS  PubMed  Google Scholar 

  12. Teschler H, Döhring J, Wang YM, Berthon-Jones M (2001) Adaptive pressure support servo-ventilation. A novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164:614–619

    Article  CAS  PubMed  Google Scholar 

  13. Andreas S, Clemens C, Sandholzer H, Figulla HR, Kreuzer H (1996) Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure. J Am Coll Cardiol 27:1486–1490

    Article  CAS  PubMed  Google Scholar 

  14. Staniforth AD, Kinnear WJM, Starling R, Hetmanski DJ, Cowley AJ (1998) Effect of oxygen on sleep quality, cognitive function and sympathetic activity in patients with chronic heart failure and Cheyne–Stokes respiration. Eur Heart J 19:922–928

    Article  CAS  PubMed  Google Scholar 

  15. Arzt M, Schulz M, Wensel R, Montalvàn S, Blumberg FC, Riegger GA, Pfeifer M (2005) Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in patients with chronic heart failure. Chest 127:794–802

    Article  PubMed  Google Scholar 

  16. Sasayama S, Izumi T, Seino Y, Ueshima K, Asanoi H (2006) Effects of nocturnal oxygen therapy on outcome measures in patients with chronic heart failure and Cheyne-Stokes respiration. Circ J 70:1–7

    Article  PubMed  Google Scholar 

  17. Toyama T, Seki R, Kasama S, Isobe N, Sakurai S, Adachi H, Hoshizaki H, Oshima S, Taniguchi K (2009) Effectiveness of nocturnal home oxygen therapy to improve exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with chronic heart failure and central sleep apnea. Circ J 73:299–304

    Article  PubMed  Google Scholar 

  18. Sasayama S, Izumi T, Matsuzaki M, Matsumori A, Asanoi H, Momomura SI, Seino Y, Ueshima K, The CHF-HOT Study Group (2009) Improvement of quality of life with nocturnal oxygen therapy in heart failure patients with central sleep apnea. Circ J 73:1255–1262

    Article  PubMed  Google Scholar 

  19. Campbell AJ, Ferrier K, Neill AM (2012) Effect of oxygen versus adaptive pressure support servo-ventilation in patients with central sleep apnoea–Cheyne Stokes respiration and congestive heart failure. Intern Med J 42:1130–1136

    Article  CAS  PubMed  Google Scholar 

  20. Bordier P, Maurice-Tison S, Ramana NK (2012) Overdrive ventricular pacing in pacemaker recipients with permanent atrial fibrillation and sleep apnea. J Clin Sleep Med 8:257–264

    PubMed Central  PubMed  Google Scholar 

  21. Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  22. Clark AL, Johnson MJ, Squire I (2011) Does home oxygen benefit people with chronic heart failure? BMJ 342:d234. doi:10.1136/bmj.d234

    Article  PubMed  Google Scholar 

  23. Naughton M, Benard D, Tam A, Rutherford R, Bradley TD (1993) Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis 148:330–338

    Article  CAS  PubMed  Google Scholar 

  24. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH (1989) Respiration and abnormal sleep in patients with congestive heart failure. Chest 96:480–488

    Article  CAS  PubMed  Google Scholar 

  25. Krieger AC, Green D, Cruz MT, Modersitzki F, Yitta G, Jelic S, Tse DS, Sedlis SP (2011) Predictors of oxidative stress in heart failure patients with Cheyne-Stokes respiration. Sleep Breath 15:827–835

    Article  PubMed  Google Scholar 

  26. Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D, Colombo PC, Basner RC, Factor P, LeJemtel TH (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117:2270–2278

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Andreas S, Plock EH, Heindl S, Scholz KH (1999) Nasal oxygen effects on arterial carbon dioxide pressure and heart rate in chronic heart failure. Am J Cardiol 83:795–798

    Article  CAS  PubMed  Google Scholar 

  28. Lorenzi-Filho G, Rankin F, Bies I, Bradley TD (1999) Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med 159:1490–1498

    Article  CAS  PubMed  Google Scholar 

  29. Solin P, Kaye DM, Little PJ, Bergin P, Richardson M, Naughton MT (2003) Impact of sleep apnea on sympathetic nervous system activity in heart failure. Chest 123:1119–1126

    Article  PubMed  Google Scholar 

  30. Andreas S, Bingeli C, Mohacsi P, Luescher TF, Noll G (2003) Nasal oxygen and muscle sympathetic nerve activity in heart failure. Chest 123:366–371

    Article  PubMed  Google Scholar 

  31. Carmona-Bernal C, Ruiz-García A, Villa-Gil M, Sánchez-Armengol A, Quintana-Gallego E, Ortega-Ruiz F, Báron-Esquivias G, Capote F (2008) Quality of life in patients with congestive heart failure and central sleep apnea. Sleep Med 9:646–651

    Article  PubMed  Google Scholar 

  32. Gottlieb JD, Schwartz AR, Marshall J, Ouyang P, Kern L, Shetty V, Trois M, Punjabi NM, Brown C, Najjar SS, Gottlieb SS (2009) Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure. J Am Coll Cardiol 54:1706–1712

    Article  PubMed Central  PubMed  Google Scholar 

  33. Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho MP, Erdmann E, Levy P, Simonds A, Somers VK, Zannad F, Teschler H (2013) Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure. Eur J Heart Fail 15:937–943

    Article  PubMed Central  PubMed  Google Scholar 

  34. Seino Y, Imai H, Nakamoto T, Araki Y, Sasayama S, for the substudy of CHF-HOT (2007) Clinical efficacy and cost-benefit analysis of nocturnal home oxygen therapy in patients with central sleep apnea caused by chronic heart failure. Circ J 71:1738–1743

    Article  PubMed  Google Scholar 

  35. Oldenburg O, Lamp B, Freivogel K, Bitter T, Langer C, Horstkotte D (2008) Low night-to-night variability of sleep disordered breathing in patients with stable congestive heart failure. Clin Res Cardiol 97:836–842

    Article  PubMed  Google Scholar 

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Acknowledgments

Special thanks to Aurelia Lataste, a registered nurse in cardiology and also a sleep technician.

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Authors and Affiliations

  1. Cardiovascular Hospital of Haut-Leveque, 4eme Ouest, Avenue de Magellan, 33604, Pessac Cedex, France

    Philippe Bordier, Sebastien Orazio, Pauline Hofmann, Frederic Robert & Ghalia Bourenane

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  1. Philippe Bordier
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  2. Sebastien Orazio
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  3. Pauline Hofmann
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  4. Frederic Robert
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  5. Ghalia Bourenane
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Correspondence to Philippe Bordier.

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Bordier, P., Orazio, S., Hofmann, P. et al. Short- and long-term effects of nocturnal oxygen therapy on sleep apnea in chronic heart failure. Sleep Breath 19, 159–168 (2015). https://doi.org/10.1007/s11325-014-0982-0

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  • DOI: https://doi.org/10.1007/s11325-014-0982-0

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