The Effect of Low Flow Oxygen on Sleep-Disordered Breathing and Oxygen Desaturation

Kearley, Richard C.; Wynne, James W.; Block, A. Jay; Boysen, Philip G.; Lindsey, Sherry; Martin, Camilo A.

doi:10.1378/chest.78.5.682

Cited by 52 publications

(14 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Calverley and coworkers" found that patients with the greatest number of episodes of hypoxaemia had the least intervening wakefulness but showed that oxygen administration improved sleep, which is in agreement with the findings of Kearley and associates. 13 By contrast, although Fleetham and coworkers'0 found an association between episodes of hypoxaemia and arousals, they found no effect of oxygen administration on sleep and a more recent study confirms this, although there was a trend towards longer sleep time with oxygen treatment. ' We conclude that patients with chronic obstructive lung disease have more sleep related symptoms and more disturbed sleep than a similarly aged population without lung disease.…”

Section: Pulmonary Function Testingmentioning

confidence: 94%

Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.

Cormick¹,

Olson²,

Hensley³

et al. 1986

Thorax

184

141

View full text Add to dashboard Cite

Fifty patients with chronic obstructive lung disease were questioned about their sleep quality and their responses were compared with those of 40 similarly aged patients without symptomatic lung disease. Patients with chronic obstructive lung disease reported more difficulty in getting to sleep and staying asleep and more daytime sleepiness than the control group. More than twice as many patients (28%) as controls (10%) reported regular use of hypnotics. In a subgroup of 16 patients with chronic obstructive lung disease (mean FEV, 0-88 (SD 0 44) 1) sleep, breathing, and oxygenation were measured to examine the relationship between night time hypoxaemia and sleep quality. Sleep architecture was disturbed in most patients, arousals occurring from three to 46 times an hour (mean 15 (SD 14)/h). Arterial hypoxaemia during sleep was common and frequently severe. The mean (SD) arterial oxygen saturation (Sao2) at the onset of sleep was 91% (7%). Nine patients spent at least 40% of cumulative sleeping time at an Sao2 of less than 90% and six of these patients spent 90% of sleeping time below this level. Only four of 15 patients did not develop arterial desaturation during sleep. The mean minimum Sao2 during episodes of desaturation was less in rapid eye movement (REM) sleep (72% (17%)) than in non-REM sleep (78% (10%); p < 0 05). The predominant breathing abnormality associated with desaturation was hypoventilation; only one patient had obstructive sleep apnoea. Arousals were related to oxygenation during sleep such that the poorer a patient's arterial oxygenation throughout the night the more disturbed his sleep (arousals/h v Sao2 at or below which 40% of the total sleep time was spent: r = 0-71, p < 0X01). Hypoxaemia during sleep was related to waking values of Sao2 and PaCo2 but not to other daytime measures of lung function.It is well recognised that sleep is associated with arterial oxygen desaturation in patients with chronic obstructive lung disease.' -6 Some physiological consequences of this desaturation, such as pulmonary hypertension, have been well investigated2 7 -9; reports of the consequences of arterial hypoxaemia in terms of quality of sleep and sleep related symptoms, however, are few and conflicting.'0'-4

show abstract

Section: Pulmonary Function Testingmentioning

confidence: 94%

Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.

Cormick¹,

Olson²,

Hensley³

et al. 1986

Thorax

184

141

View full text Add to dashboard Cite

show abstract

“…In addition, it is likely that hypoxemia per se does not disturb sleep severely. Studies in COPD and cystic fibrosis show similar results [12, 13, 14, 15]. Fleetham et al [13]observed poor sleep quality in 24 hypoxemic patients with COPD.…”

Section: Discussionmentioning

confidence: 70%

Effect of Oxygen on Sleep and Breathing in Patients with Interstitial Lung Disease at Moderate Altitude

Vázquez

Pérez‐Padilla²

2001

Respiration

View full text Add to dashboard Cite

Objective: To investigate the impact of oxygen on sleep and breathing in patients with interstitial lung disease (ILD) in Mexico City, at 2,240 m of altitude. Participants: Nineteen ILD patients with a mean FVC of 58 ± 17% pred. (SD) and a mean PaO₂ of 51 ± 6 mm Hg were recruited from a pulmonary clinic in a tertiary referral center. In addition, 14 normal control subjects, matched for age and gender, were studied. All patients underwent two consecutive full polysomnographies (PSG), one breathing room air and one breathing supplementary oxygen through nasal prongs, in random order. Controls were studied for one night breathing room air. Results: The mean oxygen saturation (SaO₂) in ILD patients was 82.3 ± 9.1% during sleep on air and 94.8 ± 2.9% on oxygen (p < 0.001). In controls it was 92.9 ± 1.9% (p < 0.001). Sleep efficiency was similar in patients and controls (75 vs. 82%, p > 0.05) and did not change with oxygen (77%). Arousal index was 12.4 ± 6.9·h^–1 in ILD patients breathing room air and 12.9 ± 9.1·h^–1 breathing oxygen while in controls it was 11.4 ± 5.4·h^–1. Breathing frequency (f) during sleep was 24.7 ± 4.2 in ILD patients and decreased breathing oxygen to 22.5 ± 3.6 (p < 0.001) but was still higher than in controls (15.6 ± 2.7; p < 0.001). Similarly, the heart rate (HR) in ILD and controls was 79 ± 12 and 68 ± 8, respectively (p < 0.001), and decreased to 68 ± 4 when patients breathed oxygen (p < 0.001). Conclusions: Oxygen substantially decreases HR and f, but does not normalize the f in ILD patients. The impact of hypoxia on sleep efficiency and arousal index was not demonstrable in our patients acclimatized to moderate altitude.

show abstract

“…The Remmers Sleep Recorder used to diagnose sleep apnoea and assess the degree of OSA correction with nocturnal oxygen and CPAP uses an automated algorithm that depends upon a fall in

S_{normala O_{2}}

to calculate the RDI. As such, it cannot accurately measure the frequency of sleep apnoea in patients using supplemental oxygen during sleep as the oxygen will blunt the decrease in

S_{normala O_{2}}

despite persistent apnoeas and/or hypopnoeas (Farney, Walker, Elmer, Viscomi, & Ord, ; Gold et al., ; Kearley et al., ; Martin et al., ; Norman et al., ; Phillips et al., ; Teramoto et al., ; Wellman et al., ). Thus, to capture the frequency of respiratory events (apnoeas and hypopnoeas) that persisted while on nocturnal oxygen therapy and compare it to the same measurements at baseline and when patients were on CPAP, a manual count of respiratory events was performed on all home sleep apnoea tests performed by each patient with OSA.…”

Section: Methodsmentioning

confidence: 99%

Vascular responses to hypoxia are not impaired in obstructive sleep apnoea patients free of overt cardiovascular disease

Beaudin

Hanly

Raneri

et al. 2019

Experimental Physiology

View full text Add to dashboard Cite

New Findings What is the central question of this study?Does treatment of obstructive sleep apnoea (OSA) with nocturnal oxygen or continuous positive airway pressure (CPAP) improve hypoxic vascular responses, which are reportedly impaired in OSA? What is the main finding and its importance?Cerebrovascular and cardiovascular hypoxic responses were not impaired in OSA patients free of overt cardiovascular disease and known risk factors, and were not altered by nocturnal oxygen or CPAP treatment. We conclude that this OSA patient phenotype has normal vascular responses to hypoxia and is unlikely to obtain long term cardiovascular benefits from nocturnal oxygen or CPAP therapy. Abstract Cerebral blood flow (CBF) and cardiovascular responses to hypoxia are reportedly impaired in obstructive sleep apnoea (OSA) patients and corrected by continuous positive airway pressure (CPAP), beneficial effects that are ascribed to correction of OSA‐related intermittent hypoxia (IH). However, CPAP corrects both IH and ancillary OSA features (i.e. intermittent hypercapnia, sympathetic activation, blood pressure surges, negative intrathoracic pressure swings and sleep fragmentation). Whether correction of these ancillary OSA features contribute to CPAP's beneficial effects on vascular hypoxic responses is unknown. Nocturnal oxygen corrects OSA‐induced IH, but apnoeas and ancillary features persist. Thus, we examined the effects of nocturnal oxygen and CPAP on cerebrovascular and cardiovascular hypoxic responses in untreated OSA patients. Responses were assessed in 52 OSA patients free of overt cardiovascular disease and known risk factors at baseline, after 2 weeks of nocturnal oxygen (n = 26) or no treatment (n = 26), and after ∼4 weeks of CPAP treatment (n = 40). Twenty‐two age‐matched controls were assessed at baseline and follow‐up visits. Resting, isocapnic euoxia mean blood pressure was decreased following nocturnal oxygen (−3.6 ± 6.0 mmHg; P = 0.006) and CPAP (−4.5 ± 7.5 mmHg; P < 0.001) while cerebrovascular conductance was increased with CPAP (P = 0.001). However, these changes were not different from controls. Unexpectedly, OSA patients and controls had similar hypoxic vascular responses at baseline that were not changed by either nocturnal oxygen or CPAP. We conclude that OSA patients free of overt cardiovascular disease and known risk factors did not have impaired cerebrovascular or cardiovascular responses to hypoxia and are unlikely to obtain long term cardiovascular benefits from nocturnal oxygen or CPAP therapy.

show abstract

The Effect of Low Flow Oxygen on Sleep-Disordered Breathing and Oxygen Desaturation

Cited by 52 publications

References 10 publications

Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.

Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.

Effect of Oxygen on Sleep and Breathing in Patients with Interstitial Lung Disease at Moderate Altitude

Vascular responses to hypoxia are not impaired in obstructive sleep apnoea patients free of overt cardiovascular disease

Contact Info

Product

Resources

About