Nocturnal oxygen therapy in obstructive sleep apnoea: a systematic review and meta-analysis

Abstract

Obstructive sleep apnoea is characterised by recurrent reduction of airflow during sleep leading to intermittent hypoxia. Continuous positive airway pressure is the first-line treatment but is limited by poor adherence. Nocturnal oxygen therapy may be an alternative treatment for obstructive sleep apnoea but its effects remain unclear. This meta-analysis evaluates the effects of nocturnal oxygen therapy on both obstructive sleep apnoea severity and blood pressure.A literature search was performed based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Peer-reviewed, randomised studies that compared the effect of nocturnal oxygen therapy to sham in obstructive sleep apnoea patients were included. The main outcomes were the apnoea–hypopnoea index and systolic and diastolic blood pressure.The search strategy yielded 1295 citations. Nine studies with 502 participants were included. When nocturnal oxygen therapy was compared to sham/air, it significantly reduced the apnoea–hypopnoea index (mean difference (MD) −15.17 events·h−1, 95% CI −19.95– −10.38 events·h−1, p<0.00001). Nocturnal oxygen therapy had no significant effect on blood pressure at follow-up without adjustment for baseline values, but did, where available, significantly attenuate the change in blood pressure from baseline to follow-up for both systolic blood pressure (MD −2.79 mmHg, 95% CI −5.45– −0.14 mmHg, p=0.040) and diastolic blood pressure (MD −2.20 mmHg, 95% CI −3.83– −0.57 mmHg, p=0.008).Nocturnal oxygen therapy reduced the apnoea–hypopnoea index severity and the change in (but not absolute) systolic and diastolic blood pressure, compared to sham. This suggests that nocturnal oxygen therapy may be a treatment option for obstructive sleep apnoea. Further studies with longer-term follow-up and standardised measurements are needed.

Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review

“…Information on the connection between hypoxia-induced insulin resistance and its clinical consequences (including CVD, CKD, and T2D) in patients with OSA may help improve the prevention and clinical management of these common conditions in clinical practice. A recent systematic review and meta-analysis that included 9 randomized studies reveals that nocturnal oxygen therapy reduces OSA severity compared to sham, suggesting that this therapy may facilitate the prevention of OSA complications [ 12 ].…”