Nocturnal Oxygen Needs and Central Sleep Apnea in Patients With Chronic Heart Failure.

NCT ID: NCT03254212

Last Updated: 2022-04-08

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE4
• Total Enrollment: 14 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-04-15
• Study Completion Date: 2022-12-31

Brief Summary

The aims of this study are to 1) determine the optimal levels of O2 flow which prevent nocturnal O2 desaturation while minimizing periods of hyperoxia during the course of nocturnal oxygen therapy (NOXT) in heart failure patients with reduced ejection fraction (HFrEF) patients with CSA/CSR; 2) document whether within-patient EO2F values change over time during NOXT, and identify factors which predict changes in EO2F; and 3) examine how well a conventional stepwise titration procedure compares to a breath by breath titration using an automated O2 titration system in terms of targeted flow rate and night time oxygenation (oxygen desaturation index, time spent at specific SpO2 targets).

Detailed Description

Sleep-related breathing disorders (obstructive and central) are highly prevalent in Heart failure (HF) patients and are associated with an increase in morbidity and mortality. Nocturnal oxygen therapy (NOT) reduces the frequency of central breathing events by 75 % and prevents nocturnal desaturation in patients with HF. Considering that the amount of nocturnal desaturation is a better predictor of mortality than the apnea+hypopnea index (AHI) in this population, one should expect NOT to have a positive impact on survival in these patients. In the four randomized clinical trials where the effects of O2 on left ventricular function was assessed, 2 reported a significant increase in LVEF after 3 months of NOT. NOT was also found to positively impact on other important predictive factors of mortality such as sympathetic activity and VO2 max. These mitigated results could be accounted by the fact that a fixed O2 flow was empirically used (2 to 4 L/min) in the majority of studies. This may impede the beneficial effects of NOT for two reasons. First, in patients with HF, oxygen is associated with a dose-related detrimental hemodynamic effects (i.e. increase in vascular resistance and reduction in cardiac output and stroke volume). Therefore, the lowest O2 flow that prevents nocturnal desaturation should be used to minimize the detrimental effects of hyperoxia. On the other hand, there are evidences that the frequency and/or severity of sleep-disordered breathing may change overtime in CHF patients leading to insufficient correction of nocturnal desaturation during the course of NOT. Therefore, NOT should be preceded by an oxygen titration procedure to determine the lowest O2 flow that prevents nocturnal desaturation. This can be done with a stepwise night-to-night increase in O2 flow until correction of nocturnal desaturation. However, another approach would be to prevent event-by-event desaturations and to prevent hyperoxia during periods of normal sleep and wakefulness. On the other hand, the stability in O2 needs overtime in these patients is unkown. The aims of this study are 1) to document if the level of O2 flow preventing nocturnal desaturation changes during the course of NOT in CHF patients with CSA/CSR and 2) to examine the ability of automated O2 titration (FreeO2, Oxynov, Quebec, Canada) to determine O2 needs in HF patients with CSA/CSR when compared to the gold standard titration procedure.

Conditions

Chronic Heart Failure; Central Sleep Apnea

Study Design

• Allocation Method: NA
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Oxygen therapy

Fixed nightime oxygen therapy throughout the protocol duration

Group Type: EXPERIMENTAL

Titration of nocturnal oxygen needs to prevent desaturations

Intervention Type: DEVICE

Oximetry recordings will be performed using a Pulse Oximeter. Two O2 titration sessions will be conducted at home in random order one week apart. One will consist of a stepwise night-to-night increase in O2 flow for up to 4 nights with supplemental O2, each at flow rates of 1L/min, 2L/min, 3L/min and 4L/min, respectively. During the other titration session, an automatic O2 delivery system will be used for 4 consecutive nights with O2 flow allowed to vary from 0 to 4 L/min with a 95 ± 2% SpO2 target. At the end of the titration periods, oxygen concentrators will be set at the lowest flow rate (1L/min to 4L/min) that maintained oxyhemoglobin saturation to \> 90% (Tsat90%) for ≥ 98% of the estimated sleep period and reduced the oxygen desaturation index 3% (ODI3) to \< 5/hour according to conventional O2 titration. If these targets are not reached, the lowest flow rate will be selected that minimizes the ODI3. These procedures will be repeated at week 5 and 11.

Interventions

Titration of nocturnal oxygen needs to prevent desaturations

Oximetry recordings will be performed using a Pulse Oximeter. Two O2 titration sessions will be conducted at home in random order one week apart. One will consist of a stepwise night-to-night increase in O2 flow for up to 4 nights with supplemental O2, each at flow rates of 1L/min, 2L/min, 3L/min and 4L/min, respectively. During the other titration session, an automatic O2 delivery system will be used for 4 consecutive nights with O2 flow allowed to vary from 0 to 4 L/min with a 95 ± 2% SpO2 target. At the end of the titration periods, oxygen concentrators will be set at the lowest flow rate (1L/min to 4L/min) that maintained oxyhemoglobin saturation to \> 90% (Tsat90%) for ≥ 98% of the estimated sleep period and reduced the oxygen desaturation index 3% (ODI3) to \< 5/hour according to conventional O2 titration. If these targets are not reached, the lowest flow rate will be selected that minimizes the ODI3. These procedures will be repeated at week 5 and 11.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• patients with heart failure and reduced ejection fraction (LVEF < 45%) due to ischemic or hypertensive heart disease
• moderate to severe central sleep apnea/cheyne stokes respiration.
• treatment should be stable for the last 30 days preceding entry into the study.

Exclusion Criteria

• O2 /CPAP therapy,
• active smoking,
• primary valvular heart disease,
• nasal obstruction,
• BMI ≥ 32 Kg/m2,
• cardiac surgery/transient ischemic attack/stroke/resynchronization therapy within 3 months,
• nocturnal hypoventilation,
• receiving opiates or methadone medication.

• Minimum Eligible Age: 21 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Oxynov

UNKNOWN

Sponsor Role: collaborator

Philips Respironics

INDUSTRY

Sponsor Role: collaborator

Laval University

OTHER

Sponsor Role: lead

Responsible Party

Frédéric Sériès

Director IUCPQ Sleep laboratory

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Frédéric Sériès

Québec, Qiebec, Canada

Site Status: RECRUITING

John Kimoff

Montreal, Quebec, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Frederic Series, MD

Role: CONTACT

frederic.series@med.ulaval.ca

418 656 8711 ext. 5513

Hugo Tremblay, MSc

Role: CONTACT

hugo.tremblay@criucpq.ulaval.ca

418 656 8711 ext. 3797

Facility Contacts

Frédéric Sériès, MD

Role: primary

frederic.series@med.ulaval.ca

418 656 4747

Frédéric Sériès, MD

Role: backup

ftrederic.series@med.ulaval.ca

418 656 4747

John Kimoff, MD

Role: primary

john.kimoff@mcgill.ca

514-934-1934

Other Identifiers

OXY-GRA-17027-LOFTHF-SH

Identifier Type: -

Identifier Source: org_study_id