• Lu Tan, Taomei Li, Yanyan Zhang, Deping He, Lian Luo, Fei Lei, Rong Ren, Jiaming He, Konrad E Bloch, and Xiangdong Tang.
• Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
• Chest. 2021 Aug 1; 160 (2): 690-700.

BackgroundThe treatment of OSA in highland residents is not established.Research QuestionsDoes nocturnal oxygen supplementation (NOS) improve sleep-related breathing disturbances, nocturnal oxygenation, and cognitive performance in patients with OSA living at 3,200 m?Study Design And MethodsForty patients with OSA permanently living in Shangri-La, China at 3,200 m (median age [interquartile range], 47.0 [44.0-53.0] years; oxygen desaturation index, 38.4/h [34.2/h-52.3/h]), were randomly assigned to receive nasal NOS and sham oxygen (ambient air), for one night each, at 2 L/min, in a crossover design, separated by a washout period of 2 weeks. During treatment nights polysomnography was performed, and further outcomes were evaluated the next morning. The primary outcome was the difference in apnea-hypopnea index (AHI) between nights with NOS and nights with sham oxygen.ResultsDuring nights with sham oxygen, the median (interquartile range) total AHI was 43.4/h (31.1/h-67.5/h), the obstructive AHI was 41.9/h (28.5/h-66.8/h), and the central AHI was 0.6/h (0.1/h-1.3/h); blood oxygenation as determined by pulse oximetry (Spo2) was 87.0% (84.5%-89.0%). In intention-to-treat analysis, NOS decreased the total AHI by a median of 17.9/h (95% CI, 8.0/h-27.1/h; P < .001), through a reduction in obstructive AHI by 16.0/h (95% CI, 6.8/h-26.0/h; P < .001) and central AHI by 0.4/h (95% CI, 0.1/h-0.9/h; P < .001). NOS also increased Spo2 by 7.0% (95% CI, 6.0%-8.0%; P < .001). Heart rate during sleep and pulse rate in the morning after NOS were significantly reduced, but subjective sleep quality and cognitive performance showed no changes.InterpretationIn highland residents with OSA, NOS significantly improved sleep-related breathing disturbances and nocturnal oxygenation. NOS also reduced heart rate during sleep and morning pulse rate. If these beneficial effects are confirmed in longer term studies, NOS may be a treatment option for highland patients with OSA who cannot be treated by CPAP.Trial RegistryChinese Clinical Trial Registry; No.: ChiCTR1800017715; URL: http://www.chictr.org.cn/showproj.aspx?proj=29768.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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