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The Effect of Oxygen on Respiration and Sleep in Patients with Congestive Heart Failure

Patrick J. Hanly, MB; Thomas W. Millar, BSc; Darlene G. Steljes, RRT; Raquel Baert, BSc; Michael A. Frais, MD; and Meir H. Kryger, MD
[+] Article, Author, and Disclosure Information

Grant Support: Supported in part by the Heart and Stroke Foundation of Canada, and the Medical Research Council of Canada.

Requests for Reprints: Meir H. Kryger, MD, Sleep Research Laboratory, Room R2008, 351 Taché Avenue, Winnipeg, Manitoba R2H 2A6 Canada.

Current Author Addresses: Dr. Hanly: 247 E.K. Jones Building, Wellesley Hospital, 160 Wellesley Street East, Toronto, Ontario M4Y 1J3, Canada.

Mr. Millar, Ms. Steljes, Ms. Baert, and Dr. Kryger: Sleep Research Laboratory, Room R2008, 351 Taché Avenue, Winnipeg, Manitoba R2H 2A6, Canada.

Dr. Frais: 5C Cardiology, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba R2H 2A6, Canada.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(10):777-782. doi:10.7326/0003-4819-111-10-777
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Study Objective: To determine the effect of supplemental oxygen on Cheyne-Stokes respiration, nocturnal oxygen saturation (SaO2), and sleep in male patients with severe, stable congestive heart failure.

Design: Randomized, single-blind, placebo-controlled crossover study.

Setting: Patients referred from outpatient cardiology clinics of 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 cannulae 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-hypopnea 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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