CHEST Guidelines-Oxygen-Therapy-in-Sleep-Disordered-Breathing_2021

Oxygen-Therapy-in-Sleep-Disordered-Breathing_2021_

Pdf Summary

The document, authored by Salam Zeineddine, MD, James A. Rowley, MD, and Susmita Chowdhuri, MD, examines oxygen therapy's role in managing sleep-disordered breathing (SDB). SDB affects many adults and can result in significant cardiovascular and neurological outcomes. Among various treatments, nocturnal supplemental oxygen (NSO) has been explored as an alternative to positive airway pressure (PAP), displaying benefits in improving oxygen saturation in obstructive sleep apnea (OSA) but proving less effective in reducing apnea severity.<br /><br />NSO's impact on daytime sleepiness is uncertain, though it may enhance physical function-related quality of life in OSA patients. However, its influence on blood pressure is inconclusive, and its effects alongside PAP in OSA with COPD (overlap syndrome) remain unexplored. NSO is effective in mitigating central sleep apnea related to congestive heart failure, with its effects on cardiovascular outcomes being studied in ongoing research.<br /><br />While NSO improves oxygen saturation in OSA, it may also prolong respiratory event duration and shows inferiority to CPAP in reducing the apnea-hypopnea index (AHI). The paper highlights the heterogeneity in NSO study durations and doses, emphasizing the need for standardized treatment criteria. For OSA cases coexisting with COPD, known as overlap syndrome, nocturnal oxygen use is considered beneficial for those experiencing significant hypoxia despite optimal pharmacotherapy.<br /><br />In central sleep apnea primarily associated with heart failure, NSO appears effective in reducing AHI by addressing hypoxic and hypercapnic components, albeit its effect on mortality or broader cardiovascular outcomes remains under investigation. Dense rationale supports further investigation into NSO’s physiological impacts, its role as an adjunctive to PAP, and broader exploration of its clinical implications and cost-effectiveness.<br /><br />Conclusively, while NSO presents potential for specific cases of SDB, its role as a substitute for established therapies like PAP is limited. Further research is crucial to fully elucidate its long-term benefits, optimal application parameters, and economic viability.

Keywords

oxygen therapy

sleep-disordered breathing

nocturnal supplemental oxygen

obstructive sleep apnea

positive airway pressure

central sleep apnea

overlap syndrome

cardiovascular outcomes

hypoxia

apnea-hypopnea index