Oxygen Therapy in Sleep-Disordered Breathing

Zeineddine, Salam; Rowley, James A.; Chowdhuri, Susmita

doi:10.1016/j.chest.2021.02.017

Cited by 19 publications

(19 citation statements)

References 101 publications

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“…This is suggested by the study of Kostikas and co-workers who observed that the appropriate CPAP pressure required for elderly patients is, on average, 2.5 mmHg less than that used for younger people adjusted by OSA severity [23,24]. Indeed COT is not a therapeutic option for patients with OSA, as it may prolong the duration of apneas although improving oxygenation [25,26]. The use of COT in COPD with nocturnal desaturation, established many years ago by the NOTT group, has been more recently disputed, while no data are currently available for patients with overlap syndrome [25,27].…”

Section: Discussionmentioning

confidence: 99%

Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea

et al. 2022

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Purpose The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is known as “overlap syndrome” (OS). Patients with OS are usually older than patients with OSA alone, suffer from more profound oxygen desaturation during the obstructive events often accompanied by sustained nocturnal hypoventilation. Although oxygen-enriched positive airway pressure (PAP) is the treatment of choice in these patients, this therapy is often poorly tolerated particularly by the elderly. The aim of this study was to assess the usefulness of nocturnal oxygen therapy via nasal high flow (NHF-OT) as a possible alternative to PAP in patients with OS. Methods Patients > 65 years old with OS and nocturnal respiratory failure (time spent below SaO2 90% (T90) > 30%) had cardio-respiratory monitoring performed at baseline, during NHF-OT, or during conventional oxygen therapy (COT). Results A total of 40 patients were enrolled in the study. NHF-OT significantly reduced the apnea–hypopnea index (AHI) in all patients compared to baseline and COT. The mean basal AHI was 25.4 ± 8.6. During COT and NHF-OT, the AHI was 19.4 ± 7 and 5.4 ± 4.6, respectively (P < 0.001) and 19 patients reached an AHI < 5 during NHF-OT. The mean nocturnal SaO2% was 86.2 ± 2.6 at baseline and at equivalent FiO2 it significantly increased to 91.8 ± 2.4 during COT and to 93.9 ± 2.5 during NHF-OT (P < 0.001). The T90% was 48.7 ± 20.1 at baseline, 16.8 ± 11.7 during COT, and 8.8 ± 8.0 during NHF-OT (P < 0.001). Conclusions In elderly patients with OS, nocturnal treatment with NHF-OT significantly reduces obstructive episodes and improves oxygenation. As the treatment is generally well tolerated compared to PAP, NHF-OT may be a possible alternative therapy in this subgroup of patients.

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Section: Discussionmentioning

confidence: 99%

Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea

et al. 2022

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“…As is well known, hypoxia diminished physiological functions and the overall quality of life. Previous studies have shown continuous positive airway pressure (CPAP) may help to improve HR-QoL, especially physical performance [24,25]. However, CPAP therapy for patients with partial laryngectomy was not adequate.…”

Section: Discussionmentioning

confidence: 99%

Impact of obstructive sleep apnea on health-related quality of life in patients with partial laryngectomy for laryngeal cancer

Chen

Shi

et al. 2022

Preprint

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Purpose To evaluate the possible risk factors of obstructive sleep apnea (OSA) and its impact on the health-related quality of life (HRQoL) in patients with partial laryngectomy for laryngeal cancer. Methods Patients who underwent partial laryngectomy for laryngeal cancer completed overnight polysomnography (PSG) home sleep tests and quality of life questionnaires. The MOS 36-item Short-Form Health Survey (SF-36) questionnaire was used to investigate factors influencing HRQoL. Results Fifty-nine patients completed PSG tests and quality of life questionnaires, with 74.6% demonstrating evidence of OSA (Apnea-hyponea Index (AHI) ranging 5.2-49.8 per hour, median 12.8 per hour). There were significant differences in tumor area and neck dissection between OSA group and non-OSA groups. Patients with OSA had significant lower scores of body pain, general health, and health transition in SF-36 domains. Independent factors associated with general health were identified as tobacco use (OR=4.716, 95% CI: 0.207-2.894), alcohol use (OR=3.193, 95% CI: 0.042-2.28), and OSA (OR=11.336, 95% CI: 0.994-3.862). Conclusion Larger tumor area and neck dissection might be associated with an increased risk for developing OSA in patients with partial laryngectomy for laryngeal cancer. OSA partially mediated the effect on physical health, including body pain, general health, and health transition. It is important to be aware of the potential impact of OSA on diminished HRQoL of these patients.

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“…Oxygen therapy has been used as an alternative to CPAP to treat OSA, and despite reducing hypoxemia, it is inferior to CPAP in both reducing AHI and improving most clinical outcomes ( Zeineddine et al, 2021 ). The degree to which non-titrated oxygen can prevent apnea/hypopnea-associated desaturations likely depends on factors such as the duration of pretreatment, the degree of airway closure during an event, and the duration of the event.…”

Section: Discussionmentioning

confidence: 99%

Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea

et al. 2021

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Obstructive sleep apnea (OSA) is considered to impair memory processing and increase the expression of amyloid-β (Aβ) and risk for Alzheimer’s disease (AD). Given the evidence that slow-wave sleep (SWS) is important in both memory and Aβ metabolism, a better understanding of the mechanisms by which OSA impacts memory and risk for AD can stem from evaluating the role of disruption of SWS specifically and, when such disruption occurs through OSA, from evaluating the individual contributions of sleep fragmentation (SF) and intermittent hypoxemia (IH). In this study, we used continuous positive airway pressure (CPAP) withdrawal to recapitulate SWS-specific OSA during polysomnography (PSG), creating conditions of both SF and IH in SWS only. During separate PSGs, we created the conditions of SWS fragmentation but used oxygen to attenuate IH. We studied 24 patients (average age of 55 years, 29% female) with moderate-to-severe OSA [Apnea-Hypopnea Index (AHI); AHI4% > 20/h], who were treated and adherent to CPAP. Participants spent three separate nights in the laboratory under three conditions as follows: (1) consolidated sleep with CPAP held at therapeutic pressure (CPAP); (2) CPAP withdrawn exclusively in SWS (OSASWS) breathing room air; and (3) CPAP withdrawn exclusively in SWS with the addition of oxygen during pressure withdrawal (OSASWS + O2). Multiple measures of SF (e.g., arousal index) and IH (e.g., hypoxic burden), during SWS, were compared according to condition. Arousal index in SWS during CPAP withdrawal was significantly greater compared to CPAP but not significantly different with and without oxygen (CPAP = 1.1/h, OSASWS + O2 = 10.7/h, OSASWS = 10.6/h). However, hypoxic burden during SWS was significantly reduced with oxygen compared to without oxygen [OSASWS + O2 = 23 (%min)/h, OSASWS = 37 (%min)/h]. No significant OSA was observed in non-rapid eye movement (REM) stage 1 (NREM 1), non-REM stage 2 (NREM 2), or REM sleep (e.g., non-SWS) in any condition. The SWS-specific CPAP withdrawal induces OSA with SF and IH. The addition of oxygen during CPAP withdrawal results in SF with significantly less severe hypoxemia during the induced respiratory events in SWS. This model of SWS-specific CPAP withdrawal disrupts SWS with a physiologically relevant stimulus and facilitates the differentiation of SF and IH in OSA.

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Oxygen Therapy in Sleep-Disordered Breathing

Cited by 19 publications

References 101 publications

Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea

Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea

Impact of obstructive sleep apnea on health-related quality of life in patients with partial laryngectomy for laryngeal cancer

Selective Continuous Positive Airway Pressure Withdrawal With Supplemental Oxygen During Slow-Wave Sleep as a Method of Dissociating Sleep Fragmentation and Intermittent Hypoxemia-Related Sleep Disruption in Obstructive Sleep Apnea

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