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.
ABSTRACT Central sleep apnea, often found in patients with chronic heart failure (CHF), has a high risk of poor prognosis.
This study involved 20 patients with CHF (left ventricular ejection fraction (LVEF) <45%, M/F =19/1, age 65+/-10 years) and an apnea-hypopnea index (AHI) >5 times/h who were divided into 2 groups: 10 patients treated with nocturnal home oxygen therapy (HOT) and 10 patients without HOT (non-HOT). All patients had dilated cardiomyopathy and underwent overnight polysomnography, cardiopulmonary exercise testing, and nuclear cardiac examinations to evaluate AHI, exercise capacity according to the specific activity scale and oxygen uptake at anaerobic threshold and peak exercise (peak VO(2)). Cardiac function according to (99m)Tc-MIBI QGS, and the total defect score (TDS), H/M ratio and the washout rate (WR) on (123)I-metaiodobenzylguanidine (MIBG) imaging were calculated for all patients. As compared with the non-HOT group, the HOT group demonstrated a greater reduction in AHI (26.1+/-9.1 to 5.1+/-3.4), (123)I-MIBG TDS (31+/-8 to 25+/-9), and (123)I-MIBG WR (48+/-8% to 41+/-5%) and a greater increase in the specific activity scale (4.0+/-0.9 to 5.8+/-1.2 Mets), peak VO(2) (16.0+/-3.8 to 18.3+/-4.7 ml . min(-1) . kg(-1)), and LVEF (27+/-9% to 37+/-10%).
HOT improves exercise capacity, cardiac function, and cardiac sympathetic nerve activity in patients with CHF and central sleep apnea.
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ABSTRACT: This paper studies the short- and long-term effects of nocturnal oxygen therapy (NOT) on sleep apnea in chronic heart failure (CHF). 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. 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. 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.Sleep And Breathing 04/2014; · 2.26 Impact Factor
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ABSTRACT: Stage D heart failure (HF) is associated with poor prognosis, yet little consensus exists on the care of patients with HF approaching the end of life. Treatment options for end-stage HF range from continuation of guideline-directed medical therapy to device interventions and cardiac transplantation. However, patients approaching the end of life may elect to forego therapies or procedures perceived as burdensome, or to deactivate devices that were implanted earlier in the disease course. Although discussing end-of-life issues such as advance directives, palliative care, or hospice can be difficult, such conversations are critical to understanding patient and family expectations and to developing mutually agreed-on goals of care. Because patients with HF are at risk for rapid clinical deterioration or sudden cardiac death, end-of-life issues should be discussed early in the course of management. As patients progress to advanced HF, the need for such discussions increases, especially among patients who have declined, failed, or been deemed to be ineligible for advanced HF therapies. Communication to define goals of care for the individual patient and then to design therapy concordant with these goals is fundamental to patient-centered care. The objectives of this white paper are to highlight key end-of-life considerations in patients with HF, to provide direction for clinicians on strategies for addressing end-of-life issues and providing optimal patient care, and to draw attention to the need for more research focusing on end-of-life care for the HF population.Journal of cardiac failure 01/2014; 20(2):121–134. · 3.25 Impact Factor
Article: Continuous Home Oxygen Therapy.[Show abstract] [Hide abstract]
ABSTRACT: Oxygen therapy is defined as the therapeutic use of oxygen and consists of administering oxygen at higher concentrations than those found in room air, with the aim of treating or preventing hypoxia. This therapeutic intervention has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be effective in other disorders. Oxygen therapy has not been shown to improve survival in patients with COPD and moderate hypoxaemia, nor is there consensus regarding its use during nocturnal desaturations in COPD or desaturations caused by effort. The choice of the oxygen source must be made on the basis of criteria such as technical issues, patient comfort and adaptability and cost. Flow must be adjusted to achieve appropriate transcutaneous oxyhaemoglobin saturation correction.Archivos de Bronconeumología 01/2014; · 2.17 Impact Factor