ABSTRACT
Chronic heart failure (CHF) is a public health problem which affects >2% of the adult population, with high morbidity, mortality, and financial cost. Sleep apnea, prevalent in >50% of patients with CHF, can aggravate vital prognosis due to worsening of heart failure. It is considered that a decrease in the apnea-hypopnea load may improve outcomes for those patients. Nocturnal non invasive ventilation can be proposed to treat sleep apnea in this situation, there being few alternatives. The present review concerns the use of nocturnal oxygen therapy (NOT) in patients suffering from both CHF and sleep apnea. The interest of NOT in this situation lies in its ability to reduce the central apnea-hypopnea index and to improve nocturnal oximetry disorders related to sleep apnea. Impact on cardiac contractility, patient tolerance, side effects, and costs of NOT are also approached as well as the underlying mechanisms of NOT. In addition, the results of the SERVE-HF trial have shown an increased death rate in patients with CHF and central sleep apnea and who were treated with adaptive servo-ventilation versus control patients. This may lead to renewed interest in NOT in those patients.
Subject(s)
Heart Failure/therapy , Oxygen Inhalation Therapy , Sleep Apnea, Central/therapy , Chronic Disease , Heart Failure/complications , Humans , Oximetry , Positive-Pressure Respiration/methods , Sleep Apnea, Central/complicationsABSTRACT
PURPOSE: This paper studies the short- and long-term effects of nocturnal oxygen therapy (NOT) on sleep apnea in chronic heart failure (CHF). METHODS: We enrolled 51 adults in New York Heart Association (NYHA) heart failure functional classes II or III, ≤45 % left ventricular ejection fraction (LVEF), in a randomized, open, single-center study. Nocturnal cardiorespiratory polygraphy showed sleep apnea [apnea-hypopnea index (AHI) ≥15 events/h] in 33 patients, of whom 19 were randomly assigned to NOT, 3.0 l/min, and 14 to no NOT. The NOT group underwent follow-up polygraphy at 24 h and 6 months, and the no NOT group a single follow-up polygraphy at 6 months. RESULTS: No significant difference was observed between baseline and 6 months in the no NOT group. In the NOT group, AHI decreased from 36.8 ± 2.6 events/h at baseline to 20.8 ± 3.0 at 24 h and to 18.3 ± 2.4 at 6 months (both P < 0.0001 vs. baseline), due to central AHI changes from 23.3 ± 2.8 events/h at baseline to 8.3 ± 1.6 at 24 h and to 6.1 ± 1.4 at 6 months (both P < 0.0001 vs. baseline). Oxygen desaturation index (ODI) decreased from 33.0 ± 5.2 events/h at baseline to 7.5 ± 0.5 at 24 h and 9.3 ± 2.6 at 6 months (both P < 0.0001 vs. baseline). NOT had no significant effect on obstructive and mixed AHI, quality of life (QOL), NYHA class, and LVEF up to 6 months of follow-up. CONCLUSIONS: NOT decreased central AHI and ODI significantly within 24 h and up to 6 months in CHF patients with sleep apnea, without significantly modifying obstructive and mixed AHI, QOL, and ventricular function.
Subject(s)
Heart Failure/therapy , Oxygen Inhalation Therapy/methods , Sleep Apnea, Obstructive/therapy , Aged , Chronic Disease , Female , Follow-Up Studies , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Male , Middle Aged , Polysomnography , Quality of Life , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , Ventricular Function, Left/physiologyABSTRACT
The possible systemic infectious consequences of prosthetic joint infections (PJI) are poorly documented in the literature. We assessed the frequency of postoperative prosthetic hip and knee infections leading to bacteremia and investigated their associated factors among patients treated between 2005 and 2009. Among 633 patients with PJI, 62 (9.8%) also had positive blood cultures (95% confidence interval (CI) 7.5-12.1). After complete investigations, the prosthesis was considered as the direct cause of bacteremia in 14 cases (2.2%; 95% CI 1.1-3.4). In the conditional logistic regression analysis, PJI leading to bacteremia was more frequently observed in cases of relapses of a prior PJI (adjusted odds ratio (aOR) 7.3, p = 0.07) and in patients with a C-reactive protein value upon admission ≥ 180 mg/l (aOR 4.5, p = 0.04). None of the 8 bacteremic patients treated with surgical debridement and prosthetic retention were cured from joint infection. These preliminary results raise concerns about the fact that debridement with prosthetic retention may not be an appropriate option in the context of PJI leading to bacteremia, contrary to PJI resulting from hematogenous seeding.
