PURPOSE: The purpose of this study is to assess the one night effects of oxygen (O2), continuous positive airway pressure (CPAP) and bilevel noninvasive positive pressure ventilation (NPPV), and one month effects of the domiciliary O2 (1M;O2) therapy on sleep apnea, cardiac function, sympathetic nervous activity and quality of life (QOL) in chronic (persistent or permanent) atrial fibrillation (AF).
METHODS: The subjects were 17 patients with chronic AF and oxygen desaturation index (ODI) 4%≧5 by ambulatory nocturnal pulse oxymeter. we performed pulse oxymeter, naisal air flow sensor, chest and abdominal wall motion, and electrocardiographic monitoring system (TEIJIN, Morpeus C) and nocturnal urinary noradrenaline (NAd) level during sleep under room air (Control:C), O2, CPAP and bilebel NPPV, and after 1M;O2 in these patients. Electrocardiogram, chest rentogenogram, echo-Doppler cardiography, Epworth sleepiness scale (ESS), Systemic activityb scale, serum NAd, BNP and h-ANP were copared before and after 1M;O2.
RESULTS: Apnea hypopnea index (AHI;/h) improved from 22(C) to 14(O2), 9(CPAP), 8(NPPV) and 12(1M;O2). Central apnea index (CAI;/h) decreased from 7.5(C) to 3.2(O2), 1.3(CPAP), 0.1(NPPV) and 3.2(1M;O2). Urinary NAd decreased from 1.1(C) to 0.9(O2), 0.9(CPAP), 0.8(NPPV) and 0.9(1M;O2). Mean heart rate (bpm) reduced from 64.1(C) to 62.6(O2), 61.9(CPAP), 60.2(NPPV) and 60.3(1M;O2). The functional class of NYHA and minimum symptom appearing activity (METs) by specific activity scale, and ESS improved from 2.5(NYHA); 4.3(METs);9.5(ESS)(before) to 2.0;4.9;6.4(1M;O2). Cardiothoracic ratio (%) decreased from 57.5(before) to 55.4(1M;O2). Left atrial dimension (LAD;mm), diastolic left ventricular dimesion (LVDd;mm) and right ventricular systolic pressure (RVsP;mmHg) decreased from 51.4(LAD); 52.6(LVDd);50(RVsP)(before) to 48.5;50.7;41(1M;O2), respectively.
CONCLUSION: One night of O2, CPAP and NPPV improved the sleep apnea and sympathetic nervous activity, and NPPV was the most effective in chronic AF. One month of domiciliary O2 improved the sleep apnea, cardiac function and QOL in chronic AF.
CLINICAL IMPLICATIONS: One night of O2, CPAP and NPPV, and 1 month of domiciliary O2 may be the useful method for improving sleep apnea, cardiac function, sympathetic nervous activity and QOL of chronic AF.
DISCLOSURE: Hitoshi Koito, No Financial Disclosure Information; No Product/Research Disclosure Information