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The effect of oxygen on respiration and sleep in patients with congestive heart failure



The effect of oxygen on respiration and sleep in patients with congestive heart failure



Annals of Internal Medicine 111(10): 777-782



Study Objective: To determine the effect of supplemental oxygen on Cheyne-Stokes respiration, nocturnal oxygen saturation (SaO2), and sheep in male patients with severe, stable congestive heart failure. Design: Randomized, single-blind, placebo-controlled crossover study. Setting: Patients referred from outpatient cardiology clinics to two teaching hospitals. Patients: Sequential sample of nine outpatients with severe, stable congestive heart failure. Interventions: For each patient, sleep studies (after an adaptation night) from two consecutive randomized nights were compared; one study was done while the patient breathed compressed air and the other while the patient breathed oxygen (O2). Compressed air and oxygen were both administered through nasal cannulate at 2 to 3 L/min. Measurements and Main Results: Cheyne-Stokes respiration, defined as periodic breathing with apnea or hypopnea, was found in all patients. Low-flow oxygen significantly reduced the duration of Cheyne-Stokes respiration (50.7% .+-. 12.0% to 24.2% .+-. 5.4% total sleep time), mainly during stage 1 NREM (non-rapid eye movement) sleep (21.3% .+-. 7.1% to 6.7% .+-. 2.3% total sleep time) with no significant change during stage 2 sleep, slow-wave sleep, or REM (rapid eye movement) sleep. Although patients had normal SaO2 (96.0% .+-. 1.7%) while awake, severe sleep hypoxemia was common; breathing oxygen reduced the amount of time that SaO2 was less than 90% from 22.3% .+-. 8.0% to 2.41% .+-. 1.93% of total sleep time. Sleep, disrupted to a variable extent in all patients, improved with oxygen therapy: There was an increase in total sleep time from 275.3 min .+-. 36.6 to 324.6 min .+-. 23.3; a reduction in the proportion of stage 1 sleep (27.6% .+-. 5.8% total sleep time to 15.2% .+-. 2.6% total sleep time); and a reduction in the number of arousals (30.4/h .+-. 8.0 to 13.8/h .+-. 1.9). The apnea-hyponea index was reduced from 30.0 .+-. 4.7 to 18.9 .+-. 2.4 with oxygen breathing. Conclusions: In severe, stable congestive heart failure, nocturnal oxygen therapy reduces Cheyne-Stokes respiration, corrects hypoxemia, and consolidates sleep by reducing arousals caused by the hyperpneic phase of Cheyne-Stokes respiration. Correction of nocturnal hypoxemia and sleep disruption may improve the clinical status of these patients.

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Accession: 007890808

Download citation: RISBibTeXText

PMID: 2817624

DOI: 10.7326/0003-4819-111-10-777


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