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

Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Circulation Journal (Impact Factor: 3.94). 12/2008; 73(2):299-304. DOI: 10.1253/circj.CJ-07-0297
Source: PubMed


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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Available from: Shu Kasama, Feb 07, 2015
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    • "The incidence of heart disease as the underlying disease was greater in the interruption group than in the other 2 groups. Because nocturnal HOT improves exercise capacity, cardiac function, and cardiac sympathetic nerve activity in patients with CHF and central sleep apnea, HOT has been recognized as a valuable nonpharmacological option for the treatment of patients with CHF [3] [5] [17]. Therefore, in Japan, nocturnal HOT for patients with CHF and central sleep apnea has been covered by the Japanese National Health Insurance System since 2004 and was used before the spread of adaptive servo-ventilation therapy. "
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    ABSTRACT: After the Great East Japan Earthquake, oxygen-dependent patients in areas experiencing power outages could not continue home oxygen therapy (HOT) without oxygen cylinders. The purpose of this study was to examine use of oxygen cylinders in areas experiencing power outages and the effects of HOT interruption on patients' health. Questionnaires were mailed to 1106 oxygen-dependent patients and HOT-prescribing physicians in Akita, near the disaster-stricken area. We investigated patients' actions when unable to use an oxygen concentrator and classified the patients based on oxygen cylinder use. Patients who experienced an interruption of or reduction in oxygen flow rate by their own judgment were assigned to the "interruption" and "reduction" groups, respectively; those who maintained their usual flow rate were assigned to the "continuation" group. Differences were tested using analysis of variance and the χ(2) tests. In total, 599 patients responded to the questionnaire. Oxygen cylinders were supplied to 574 patients (95.8%) before their oxygen cylinders were depleted. Comparison of the continuation (n=356), reduction (n=64), and interruption (n=154) groups showed significant differences in family structure (p=0.004), underlying disease (p=0.014), oxygen flow rate (p<0.001), situation regarding use (p<0.001), knowledge of HOT (p<0.001), and anxiety about oxygen supply (p<0.001). There were no differences in changes in physical condition. Most patients could receive oxygen cylinders after the disaster. Some patients discontinued their usual oxygen therapy, but their overall health status was not affected.
    03/2013; 51(1):9-16. DOI:10.1016/j.resinv.2012.10.005
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    • "Therefore, patient QOL ameliorates along with improvements in sleep architecture, shortness of breath and fatigue during daytime, and cognitive function [52]. Nocturnal oxygen therapy might also have long-term efficacy, as sympathetic activity is decreased in patients with chronic HF and CSA [53]. Angiotensin-converting enzyme inhibition can improve AHI and nocturnal oxygen desaturation in patients with mild-to-moderate HF [54]. "
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    ABSTRACT: Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30–50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2 therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF.
    Pulmonary Medicine 02/2013; 2013:814169. DOI:10.1155/2013/814169
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    • "In the 1-year study, home oxygen therapy (HOT) was well tolerated and the benefit on LV function and quality of life observed in the 12- week trial was maintained over a prolonged period although this study failed to show benefit on the primary composite cardiac endpoints of combined rate of cardiac death, hospitalization because of worsening heart failure, and a decrease in the Specific Activity Scale by ≥1 Mets, because of the small sample size. Another randomized study reported by Japanese researchers demonstrated that HOT improves exercise capacity, cardiac function, and cardiac sympathetic nerve activity in patients with congestive heart failure and CSA [22]. Thus, in Japan, HOT is approved for reimbursement by public health insurance in patients with NYHA class III or IV, with optimal medical therapy for heart failure and AHI higher than 20 by polysomnography. "
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    ABSTRACT: Sleep disordered breathing including obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR) is often accompanied by heart failure. Treatment of OSA centered on continuous positive airway pressure (CPAP) is established. However, treatment of CSR-CSA is still controversial. Since CSR-CSA occurs as a consequence of heart failure, optimization of heart failure is essential to treat CSR-CSA. For treatment directed at CSR-CSA itself, a variety of treatment approaches including night oxygen therapy and noninvasive positive pressure ventilation have been applied. Among them, night oxygen therapy improves patients' symptoms, quality of life (QOL), and left ventricular function, but had yet been shown to improve clinical outcome. For CPAP, there are responders and non-responders and for responders CPAP can also improve survival. Adaptive servo-ventilation (ASV), which most effectively treats CSR-CSA, improves exercise capacity, QOL, and cardiac function. Recent reports suggested ASV may also prevent cardiac events in patients with heart failure. However, further studies are needed to conclude that this treatment improves patient survival.
    Journal of Cardiology 03/2012; 59(2):110-6. DOI:10.1016/j.jjcc.2011.12.008 · 2.78 Impact Factor
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