Chest

Chest

Volume 116, Issue 6, December 1999, Pages 1550-1557
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Clinical Investigations
Sleep & Breathing
Comparison of Oxygen Therapy With Nasal Continuous Positive Airway Pressure on Cheyne-Stokes Respiration During Sleep in Congestive Heart Failure

https://doi.org/10.1378/chest.116.6.1550Get rights and content

Study objectives

Both oxygen therapy and nasal continuous positive airway pressure (CPAP) therapy have independently been shown to be effective in the treatment of Cheyne-Stokes respiration (CSR) in patients with congestive heart failure (CHF). The purpose of this study was to compare the short-term effects of oxygen therapy and nasal CPAP therapy on CSR in a group of stable patients with severe CHF.

Design

Prospective, randomized, controlled trial.

Setting

University hospital.

Patients

Twenty-five stable patients (mean [± SD] age, 56 ± 9) with CHF and a mean left ventricular ejection fraction (LVEF) of 17 ± 0.8%.

Interventions and measurements

All patients had a right heart catheterization prior to the study and an echocardiogram performed to measure LVEF. In addition, all patients had an initial sleep study to identify the presence of CSR. Sleep studies included continuous recordings of breathing pattern, pulse oximetry, and EEG. Those patients identified as having CSR were randomized to a night on oxygen therapy (2 L/min by nasal cannula) and another night on nasal CPAP therapy (9 ± 0.3 cm H2O).

Results

Fourteen of the 25 patients (56%) studied had CSR (apnea hypopnea index [AHI], 36 ± 7 events per hour) during their initial sleep study. Nine of the 14 patients with CSR completed the study. When compared with baseline measurements, both oxygen therapy and nasal CPAP therapy significantly decreased the AHI (from 44 ± 9 to 18 ± 5 and 15 ± 8 events per hour, respectively; p < 0.05), with no significant difference between the two modalities. The mean oxygen saturation increased significantly and to a similar extent with oxygen therapy and nasal CPAP therapy (from 93 ± 0.7% to 96 ± 0.8% and 95 ± 0.7%, respectively; p < 0.05), as did the lowest oxygen saturation during the night (from 80 ± 2% to 85 ± 3% and 88 ± 2%, respectively; p < 0.05). In addition, the mean percent time the oxygen saturation was < 90% also improved with both interventions (from a baseline of 17 ± 5 to 6 ± 3% with oxygen therapy and 5 ± 2% with nasal CPAP therapy; p < 0.05). When compared with baseline measurements, the apnea-hypopnea length, cycle length, circulation time, and heart rate did not significantly change with either oxygen therapy or nasal CPAP therapy. Total sleep time and sleep efficiency decreased only with nasal CPAP therapy (from 324 ± 20 to 257 ± 14 min, and from 82 ± 3 to 72 ± 2%, respectively; p < 0.05). The arousal index, when compared with baseline, remained unchanged with both oxygen therapy and nasal CPAP therapy.

Conclusion

CSR occurs frequently in stable patients with severe CHF. In addition, oxygen therapy and nasal CPAP therapy are equally effective in decreasing the AHI in those CHF patients with CSR.

Section snippets

Patient Selection

Twenty-five consecutive stable patients with severe (NYHA class IV) CHF were studied. All patients were clinically stable for at least 4 weeks prior to the study, with no change in their medications for a 2-week period (17 ± 4 days) prior to the start of the study as well as during the entire study period. The protocol was approved by our institutional review board, and informed consent was obtained from each patient prior to the study. Patients were excluded from the study if they (1) had an

Patient Characteristics

Twenty-five patients (24 men and 1 woman) with a mean (± SD) age of 56 ± 9 years and body mass index (BMI) of 28 ± 1 kg/m2 were studied (Table 1). All patients were stable with NYHA class IV CHF and a mean LVEF of 17 ± 0.8%. Patients were maximized on their medications prior to the study, including the use of a continuous inotropic infusion of either dobutamine (n = 20) at 5 ± 0.3 μg/kg/min or milrinone (n = 5) at 0.4 ± 0.1 μg/kg/min through an indwelling central venous catheter. Baseline

Discussion

We studied a homogeneous group of stable patients with severe CHF who were awaiting heart transplantation. All were medically optimized prior to the study, with no change in their medical regimen for a 2-week period prior to the start of the study as well as during the entire study period. The present study has the following two significant findings: (1) that sleep-disordered breathing of the Cheyne-Stokes variety occurred in greater than half the patients (56%) who were stable with severe CHF;

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    Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.