Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes respiration during sleep in congestive heart failure

Study objectives: Both oxygen therapy and nasal continuous positive airway pressure (CPAP) therapy ha ce independently been shown to be effective in t he treatment of Cheyne-Stokes respiration (CSR) in patients with congestive heart failure (CHP). The purpose of this study was to compare the short-te rm effects of oxygen therapy and nasal CPAP therapy on CSR in a group of st able patients with severe CHF. Design: Prospective, randomized, controlled trial. Setting: University hosp ital. Patients: Twenty-five stable patients (mean [+/- SD] age, 56 +/- 9) w ith CHF and a mean left ventricular ejection fraction (LVEF) of 17 +/- 0.8% . Interventions and measurements: All patients had a light heart catheteriz ation prior to the study and an echocardiogram performed to measure LVEF. I n addition, all patients had an initial sleep study to identify the presenc e of CSR. Sleep studies included continuous recordings of breathing pattern , pulse oximetry, and EEG. Those patients identified as having CSR were ran domized 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.. N ine of the 14 patients with CSR completed the study. When compared with bas eline measurements, both oxygen therapy and nasal CPAP therapy significantl y decreased the AHI (from 44 +/- 9 to 18 +/- 5 and 15 +/- 8 events per hour , respectively; p < 0.05), with no significant difference been een the tno modalities. The mean oxygen saturation increased significantly and to a sim ilar extent with oxygen ther ny! and nasal CPAP therapy (from 93 +/- 0.7% t o 96 +/- 0.8% and 95 +/- 0.7%, respectively; p < 0.05), as did the lowest o xygen saturation Juring the night (from 80 +/- 2% to 85 +/- 3% and 88 +/- 2 %, respectively; p < 0.05). In addition, the mean percent time the oxygen s aturation 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 th erapy; p < 0.05). When compared with baseline measurements, the apnea-hypop nea length, cycle length, circulation time, and heart rate did not signific antly 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 +/- 11 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. Ill a ddition, oxygen therapy and nasal CPAP therapy are equally effective in dec reasing the AHI in those CHF patients with CSR.