Chest
Volume 111, Issue 1, January 1997, Pages 163-169
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Clinical Investigations: Sleep and Breathing
Reversal of Central Sleep Apnea With Oxygen

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Objective

To examine the effect of oxygen on apneas and sleep quality in patients with frequent central apneas during sleep.

Design/subjects

Prospective intervention study of 20 consecutive patients with predominant central apnea identified from 570 patients referred for suspected sleep apnea syndrome. Sixteen patients had congestive heart failure and seven of them had a previous stroke. Three of the remaining four patients without heart failure had experienced a previous stroke, and one was being treated with morphine.

Setting

The Department of Pulmonary Medicine at Umeå (Sweden) University Hospital. Interventions: The patients were investigated for one night receiving nasal oxygen and one night without it.

Measurements

Overnight polysomnography with transcutaneous Pco2 and arterial blood gases. Results: Central apneas occurred during Cheyne-Stokes respiration in 18 of 20 patients and two patients had idiopathic central apneas. Without oxygen, the median number of all central apneas and hypopneas was 33.5 (range, 8.0 to 52.0) per hour of sleep. These episodes decreased to 5.0 (range, 0.0 to 31.0) (p<0.01) during oxygen therapy. In 17 of 20 patients, the frequency of central apneas was reduced by more than 50%. Central apneas were reduced by oxygen irrespective of the presence or absence of heart failure or Cheyne-Stokes respiration. The arousal frequency was reduced during oxygen treatment. Daytime sleepiness, difficulty falling asleep, snoring, and self-scored awakenings were reduced in seven patients who were given nocturnal oxygen at home. Obstructive and mixed apneas were unaffected by oxygen.

Conclusions

Oxygen effectively reduces central sleep apnea in eucapnic patients.

Section snippets

Patients

Twenty consecutive patients with predominantly central apneas were studied. They were identified from 570 patients referred for a respiratory sleep recording because of suspected sleep apnea syndrome. All but one were men and they all had more than 10 central apneas per hour of sleep. No drug therapy was withdrawn before or during the sleep study. The median age was 68.5 years (range, 38 to 80 years) and the median body mass index was 27.0 kg/m2 (range, 19.7 to 46.7 kg/m2). All the patients

Apnea and Sleep

Central apnea occurred during Cheyne-Stokes respiration in 18 of 20 patients (Table 2). None had central apnea only at sleep onset. The median central apnea-hypopnea index was 33.5 (range, 8.0 to 52.0) during the first night without oxygen. The median obstructive apnea-hypopnea index was 3.6 (range, 0.3 to 29.4) and the median mixed apnea-hypopnea index was 0.0 (range, 0.0 to 5.8). The central apnea-hypopnea index was reduced to 5.0 (range, 0.0 to 31.0) (p<0.01) during oxygen therapy (Fig 1).

DISCUSSION

There are few studies on the treatment for central apnea and Cheyne-Stokes respiration, despite the fact that the disorder has been well known since the 19th century.9, 10 The main findings in the present study were that the number of central apneas was reduced by oxygen in all patients and that the reduction was marked in most of them. Most patients had congestive heart failure and central apnea during Cheyne-Stokes respiration. However, oxygen was also effective in those patients without

ACKNOWLEDGMENTS

This study was conducted in the sleep laboratory in the Department of Pulmonary Medicine. Eva Svanborg, MD, PhD is acknowledged for her valuable comments and Bengt Lundkvist for statistical advice.

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  • Cited by (0)

    This study was supported by grants from the Swedish Heart and Lung Foundation and the Swedish Association for Heart and Lung Patients.

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