Wednesday, March 29, 2006

Quick sleep question

This has come up in discussions with one of our neurologists who also sees sleep patients.
Many patients with OSA are hypoxic at night and that is clearly due to the apnea/obstruction and not due to gas exchange abnormalities or structural lung Dz. Some of these patients come to us already on nighttime O2 but not CPAP/BiPAP. A small group of these patients cannot stand or won't give CPAP/BiPAP a chance and some don't want to try ENT surgical options either. However, they are willing to sleep with a nasal cannula... Would you continue with O2 (assuming you HAVE already tried to talk them into nasal pillows, nasal CPAP, etc.) in this case? Is it of benefit at all?

3 comments - CLICK HERE to read & add your own!:

Jeff H said...

I think that is a great question. I do not know the sleep literature at all, but with a quick lit search I found the following:

1) Treatment with 1-2L oxygen (but not compressed air), increased NO levels in patients with OSA, suggesting a "vasodilatory effect." This could impact pulmonary hypertension in these patients.
*Teramoto, Sleep Med. 2003 Sep;4(5):403-7

2)Oxygen treatment (with a non-rebreather) can decrease sympathetic nerve activity in patients with OSA, and thereby attenuate hypoxia-related vasoconstriction and hypertension associated with apneic episodes
*Imadojemu VA, Am J Respir Crit Care Med. 2002 Jan 1;165(1):61-6.

3) "Oxygen administration for the correction of OSA-related nocturnal hypoxemia was both safe and effective in alleviation of OSA-related symptoms. It also appeared to have a beneficial effect on minimum oxygen saturation levels. Thus, oxygen therapy may be considered a treatment option in patients who fail to comply with CPAP and are not candidates for a surgical procedure."
*Landsberg R, Am J Rhinol. 2001 Sep-Oct;15(5):311-3

4) However, nocturnal oxygen administration does not improve intelligence in men who snore.
*Block AJ, Chest. 1989 Feb;95(2):274-8.

5) Low flow oxygen improved sleep architecture and patients felt better, but did not perform better on a multiple-sleep-latency test
*Smith PL,Am Rev Respir Dis. 1984 Dec;130(6):958-63

So, looks like a reasonable intervention to me. And, that will be the extent of my reading regarding the sleep disordered breathing for the rest of the year.

Mike L said...

The only thing that would worry me is that nocturnal oxygen can worsen central apneas.

Has your patient tried the nasal pillows; it is not much different than nasal prongs.

Nonetheless, I have prescribed nasal oxygen with
the hope of preventing the cardiovascular side effects (see JCH references) and attempting to "play-up" the EDS side effects in the patients so they ultimately decide to use CPAP.

Another thing that you could try is a dental appliance. There are plenty of sites on the web that advertise. I am sure that some dentists in rural Tennessee who make them...

Anonymous said...

Oxygen can actually stabilize sleep stage and prevent central sleep apnea. Furthermore, oxygen can actually improve OSA thru central mechanisms (loop gain etc). I have read at least two studies in past week where our tech started patient on O2 when they refused CPAP during split night PSG. In both, there was a significant decrease in AHI. However, if OSA is severe, I would continue to push patient for CPAP therapy.