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

Toyama, Takuji; Seki, Ryotaro; Kasama, Shu; Isobe, Naoki; Sakurai, Shigeki; Adachi, Hitoshi; Hara, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi

doi:10.1253/circj.cj-07-0297

Cited by 77 publications

(33 citation statements)

References 23 publications

(17 reference statements)

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“…For instance, adaptive servo-ventilation (ASV), the most effective treatment method for CSA with Cheyne-Stokes respiration (CSR-CSA), increases peak V O2, AT level, and 6-minute walking distance as compared with continuous positive airway pressure (CPAP) 198 and nocturnal HOT improves SDB as well as exercise outcome measures such as peak V O2 and AT level. 199 However, studies reporting such findings are not randomized control studies.…”

Section: (4) Cardiac Rehabilitation and Disease Managementmentioning

confidence: 99%

Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012)

2014

Circ J

234

150

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Section: (4) Cardiac Rehabilitation and Disease Managementmentioning

confidence: 99%

Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012)

2014

Circ J

234

150

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“…28 There are some studies in a small number of patients investigating the effects of short-term overnight oxygen therapy which suggest that there may be some beneficial effect. For example, Toyama et al 29 studied 20 patients and found improvements in exercise capacity and cardiac function in the 10 patients randomised to overnight oxygen. Other small studies have found similar beneficial effects, but there is no systematic review available.…”

Section: Sleep Apnoeamentioning

confidence: 99%

“…The apnoea-hypopnoea index (AHI) is used to indicate the severity of sleep apnoea and represents the number of apnoea and hypopnoea events per hour of sleep. AHI values are categorised as normal (0-4), mild sleep apnoea (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), moderate sleep apnoea (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) and severe sleep apnoea (30+). Considering that both AHI and oxygen saturation can give an overall assessment of the sleep apnoea severity.…”

Section: Oxygen Suppliers' Meter Readingsmentioning

confidence: 99%

Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure

Clark

Johnson

Fairhurst

et al. 2015

Health Technol Assess

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BackgroundHome oxygen therapy (HOT) is commonly used for patients with severe chronic heart failure (CHF) who have intractable breathlessness. There is no trial evidence to support its use.ObjectivesTo detect whether or not there was a quality-of-life benefit from HOT given as long-term oxygen therapy (LTOT) for at least 15 hours per day in the home, including overnight hours, compared with best medical therapy (BMT) in patients with severely symptomatic CHF.DesignA pragmatic, two-arm, randomised controlled trial recruiting patients with severe CHF. It included a linked qualitative substudy to assess the views of patients using home oxygen, and a free-standing substudy to assess the haemodynamic effects of acute oxygen administration.SettingHeart failure outpatient clinics in hospital or the community, in a range of urban and rural settings.ParticipantsPatients had to have heart failure from any aetiology, New York Heart Association (NYHA) class III/IV symptoms, at least moderate left ventricular systolic dysfunction, and be receiving maximally tolerated medical management. Patients were excluded if they had had a cardiac resynchronisation therapy device implanted within the past 3 months, chronic obstructive pulmonary disease fulfilling the criteria for LTOT or malignant disease that would impair survival or were using a device or medication that would impede their ability to use LTOT.InterventionsPatients received BMT and were randomised (unblinded) to open-label LTOT, prescribed for 15 hours per day including overnight hours, or no oxygen therapy.Main outcome measuresThe primary end point was quality of life as measured by the Minnesota Living with Heart Failure (MLwHF) questionnaire score at 6 months. Secondary outcomes included assessing the effect of LTOT on patient symptoms and disease severity, and assessing its acceptability to patients and carers.ResultsBetween April 2012 and February 2014, 114 patients were randomised to receive either LTOT or BMT. The mean age was 72.3 years [standard deviation (SD) 11.3 years] and 70% were male. Ischaemic heart disease was the cause of heart failure in 84%; 95% were in NYHA class III; the mean left ventricular ejection fraction was 27.8%; and the median N-terminal pro-B-type natriuretic hormone was 2203 ng/l. The primary analysis used a covariance pattern mixed model which included patients only if they provided data for all baseline covariates adjusted for in the model and outcome data for at least one post-randomisation time point (n = 102: intervention,n = 51; control,n = 51). There was no difference in the MLwHF questionnaire score at 6 months between the two arms [at baseline the mean score was 54.0 (SD 18.4) for LTOT and 54.0 (SD 17.9) for BMT; at 6 months the mean score was 48.1 (SD 18.5) for LTOT and 49.0 (SD 20.2) for BMT; adjusted mean difference –0.10, 95% confidence interval (CI) –6.88 to 6.69;p = 0.98]. At 3 months, the adjusted mean MLwHF questionnaire score was lower in the LTOT group (–5.47, 95% CI –10.54 to –0.41;p = 0.03) and breathlessness scores improved, although the effect did not persist to 6 months. There was no effect of LTOT on any secondary measure. There was a greater number of deaths in the BMT arm (n = 12 vs.n = 6). Adherence was poor, with only 11% of patients reporting using the oxygen as prescribed.ConclusionsAlthough the study was significantly underpowered, HOT prescribed for 15 hours per day and subsequently used for a mean of 5.4 hours per day has no impact on quality of life as measured by the MLwHF questionnaire score at 6 months. Suggestions for future research include (1) a trial of patients with severe heart failure randomised to have emergency oxygen supply in the house, supplied by cylinders rather than an oxygen concentrator, powered to detect a reduction in admissions to hospital, and (2) a study of bed-bound patients with heart failure who are in the last few weeks of life, powered to detect changes in symptom severity.Trial registrationCurrent Controlled Trials ISRCTN60260702.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 75. See the NIHR Journals Library website for further project information.

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“…Nocturnal oxygen therapy eliminates nocturnal oxyhemoglobin desaturation, improves VO 2 max (see [2] and [52]), and also in randomized clinical trials increases LVEF and quality of life [55][56][57].…”

Section: Central Sleep Apneamentioning

confidence: 99%

Sleep disordered breathing in patients with heart failure

Krawczyk¹,

Flinta²,

Garncarek³

et al. 2013

Cardiol J

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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

Cited by 77 publications

References 23 publications

Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012)

Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012)

Does home oxygen therapy (HOT) in addition to standard care reduce disease severity and improve symptoms in people with chronic heart failure? A randomised trial of home oxygen therapy for patients with chronic heart failure

Sleep disordered breathing in patients with heart failure

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