Hanly P J, Millar T W, Steljes D G, Baert R, Frais M A, Kryger M H
University of Manitoba, Winnipeg, Manitoba, Canada.
Ann Intern Med. 1989 Nov 15;111(10):777-82. doi: 10.7326/0003-4819-111-10-777.
To determine the effect of supplemental oxygen on Cheyne-Stokes respiration, nocturnal oxygen saturation (SaO2), and sleep in male patients with severe, stable congestive heart failure.
Randomized, single-blind, placebo-controlled crossover study.
Patients referred from outpatient cardiology clinics of two teaching hospitals.
Sequential sample of nine outpatients with severe, stable congestive heart failure.
For each patient, sleep studies (after an adaptation night) from two consecutive randomized nights were compared; one study was done while the patient breathed compressed air and the other while the patient breathed oxygen (O2). Compressed air and oxygen were both administered through nasal cannulae at 2 to 3 L/min.
Cheyne-Stokes respiration, defined as periodic breathing with apnea or hypopnea, was found in all patients. Low-flow oxygen significantly reduced the duration of Cheyne-Stokes respiration (50.7% +/- 12.0% to 24.2% +/- 5.4% total sleep time), mainly during stage 1 NREM (non-rapid eye movement) sleep (21.3% +/- 7.1% to 6.7% +/- 2.3% total sleep time) with no significant change during stage 2 sleep, slow-wave sleep, or REM (rapid eye movement) sleep. Although patients had normal SaO2 (96.0% +/- 1.7%) while awake, severe sleep hypoxemia was common; breathing oxygen reduced the amount of time that SaO2 was less than 90% from 22.3% +/- 8.0% to 2.41% +/- 1.93% of total sleep time. Sleep, disrupted to a variable extent in all patients, improved with oxygen therapy: There was an increase in total sleep time from 275.3 min +/- 36.6 to 324.6 min +/- 23.3; a reduction in the proportion of stage 1 sleep (27.6% +/- 5.8% total sleep time to 15.2% +/- 2.6% total sleep time); and a reduction in the number of arousals (30.4/h +/- 8.0 to 13.8/h +/- 1.9). The apnea-hypopnea index was reduced from 30.0 +/- 4.7 to 18.9 +/- 2.4 with oxygen breathing.
In severe, stable congestive heart failure, nocturnal oxygen therapy reduces Cheyne-Stokes respiration, corrects hypoxemia, and consolidates sleep by reducing arousals caused by the hyperpneic phase of Cheyne-Stokes respiration. Correction of nocturnal hypoxemia and sleep disruption may improve the clinical status of these patients.
确定补充氧气对重度、稳定型充血性心力衰竭男性患者的潮式呼吸、夜间血氧饱和度（SaO₂）及睡眠的影响。
随机、单盲、安慰剂对照交叉研究。
来自两家教学医院门诊心脏病科的患者。
连续选取9例重度、稳定型充血性心力衰竭门诊患者。
对每位患者，比较连续两个随机夜间（经过一个适应夜后）的睡眠研究结果；一项研究是患者呼吸压缩空气时进行，另一项是患者呼吸氧气（O₂）时进行。压缩空气和氧气均通过鼻导管以2至3L/分钟的流量给予。
所有患者均出现潮式呼吸，即伴有呼吸暂停或呼吸浅慢的周期性呼吸。低流量氧气显著缩短了潮式呼吸的持续时间（占总睡眠时间的比例从50.7%±12.0%降至24.2%±5.4%），主要在NREM（非快速眼动）睡眠1期（占总睡眠时间的比例从21.3%±7.1%降至6.7%±2.3%），而在睡眠2期、慢波睡眠或REM（快速眼动）睡眠期无显著变化。尽管患者清醒时SaO₂正常（96.0%±1.7%），但严重的睡眠低氧血症很常见；呼吸氧气使SaO₂低于90%的时间占总睡眠时间的比例从22.3%±8.0%降至2.41%±1.93%。所有患者的睡眠均有不同程度的紊乱，吸氧治疗后有所改善：总睡眠时间从275.3分钟±36.6增加至324.6分钟±23.3；睡眠1期所占比例降低（从占总睡眠时间的27.6%±5.8%降至15.2%±2.6%）；觉醒次数减少（从30.4次/小时±8.0降至13.8次/小时±1.9）。呼吸氧气时呼吸暂停低通气指数从30.0±4.7降至18.9±2.4。
在重度、稳定型充血性心力衰竭患者中，夜间氧疗可减少潮式呼吸，纠正低氧血症，并通过减少潮式呼吸高通气期引起的觉醒巩固睡眠。纠正夜间低氧血症和睡眠紊乱可能改善这些患者的临床状况。
