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The Impact of Low Flow Nocturnal Oxygen Therapy on Hospital Admissions and Mortality in Patients With Heart Failure and Central Sleep Apnea

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03745898
Recruitment Status : Recruiting
First Posted : November 19, 2018
Last Update Posted : February 11, 2021
Ohio State University
Information provided by (Responsible Party):
Susan Redline, Brigham and Women's Hospital

Brief Summary:
The purpose of this trial is to evaluate the long-term effects of Nocturnal Oxygen Therapy (NOXT) on the mortality and morbidity of patients with stable heart failure and a reduced ejection fraction (HFrEF), already receiving optimal guideline-directed medical therapy (GDMT), who have central sleep apnea (CSA).

Condition or disease Intervention/treatment Phase
Heart Failure Central Sleep Apnea Drug: Oxygen Other: Room Air Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 858 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: The Impact of Low Flow Nocturnal Oxygen Therapy on Hospital Admissions and Mortality in Patients With Heart Failure and Central Sleep Apnea (LOFT-HF)
Actual Study Start Date : April 15, 2019
Estimated Primary Completion Date : February 2023
Estimated Study Completion Date : February 2023

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Nocturnal Oxygen Therapy
Active nocturnal oxygen therapy
Drug: Oxygen
Active nocturnal oxygen concentrator

Sham Comparator: Sham Nocturnal Oxygen Therapy
Sham nocturnal oxygen therapy (room air)
Other: Room Air
Sham nocturnal oxygen concentrator (room air)
Other Name: Sham Oxygen

Primary Outcome Measures :
  1. First occurrence of mortality due to any cause or an unplanned hospitalization for worsening heart failure or a life-saving cardiovascular (CV) intervention [ Time Frame: Through study completion, an average of 2.5 years ]
    This is a composite primary outcome

Secondary Outcome Measures :
  1. Recurrent event analyses of morbidity [ Time Frame: Through study completion, an average of 2.5 years ]
  2. Recurrent event analyses of mortality [ Time Frame: Through study completion, an average of 2.5 years ]
  3. Exercise capacity [ Time Frame: 12 months ]
    Exercise capacity will be assessed by the change in 6-minute hall walk distance (6MHWD) test

  4. Quality of Life and Symptoms - HF disease-specific quality of life [ Time Frame: 12 months ]
    HF disease-specific quality of life will be assessed by the change in the Kansas City Cardiomyopathy Questionnaire (KCCQ). The KCCQ quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life for those who have heart failure. An overall summary score is derived from the physical function, symptom (frequency and severity), social function and quality of life domains. Scores are transformed to a range of 0-100, in which higher scores reflect better health status.

  5. Quality of Life and Symptoms - Generic-quality of life [ Time Frame: 12 months ]
    Generic-quality of life will be assessed by the change in the Euroqol - 5 Dimensions (EQ-5D) questionnaire. The questionnaire comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. There is no total score or range.

  6. Quality of Life and Symptoms - Depressive symptoms [ Time Frame: 12 months ]
    Depressive symptoms will be assessed by the change in the Patient Health Questionnaire - 8 items (PHQ-8). A scores ranges from 0 to 24. A score greater than 10 is considered major depression and a score 20 or more is considered severe major depression.

  7. Quality of Life and Symptoms - Sleep symptoms and sleep related daytime impairment [ Time Frame: 12 months ]
    Sleep symptoms and sleep related daytime impairment will be assessed by the change in the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance and Sleep Related Impairment Questionnaires. Scores range from 8 - 40. The final score is represented by the T-score, a standardized score with a mean of 50 and a standard deviation (SD) of 10.

  8. Functional Status [ Time Frame: 12 months ]
    Functional status will be assessed by the change in New York Heart Association (NYHA) Functional Class Ranking

Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Aged ≥ 21 years at the date of consent.
  • History of chronic, stable heart failure with reduced ejection fraction with left ventricular ejection fraction (LVEF) ≤ 50% determined by echocardiography, radionuclide angiography, left ventriculography, or cardiac magnetic resonance imaging, within the year prior to enrollment.
  • Central sleep apnea, defined using as an apnea-hypopnea index (AHI) > 15/h with ≥ 50% central events (apnea and hypopneas).
  • New York Heart Association (NYHA) Class III or IV, or NYHA Class II with any of the following:

    1. at least one hospitalization for heart failure within the 24 months prior to enrollment or;
    2. a BMI corrected BNP ≥ 300 pg/ml or a corrected NT-proBNP ≥ 1500 pg/ml or;
    3. an ED visit for HF exacerbation where the patient has received an IV diuretic within 12 months of enrollment.
  • Treatment with stable, optimized guideline-directed medical therapies (GDMT) according to applicable guidelines in the U.S. and Canada, where stable is defined as the addition of no new class of disease-modifying drug for ≥ 30 days prior to randomization (reasons for intolerance to GDNT must be documented).
  • In the investigator's opinion, willing and able to comply with all study requirements.
  • Able to fully understand study information and sign an Institutional Review Board (IRB) approved informed consent (including HIPAA authorization in the U.S.).

Exclusion Criteria:

  • Current positive airway pressure use or predominantly obstructive rather than central sleep apnea.
  • Oxygen saturation < 90% at rest during the day.
  • Nocturnal oxygen saturation < 88% for > 5 continuous minutes unaccompanied by apneas or hypopneas.
  • Chronic daytime or nighttime use of supplemental oxygen.
  • Participants and their bed-partners who currently smoke in the bedroom.
  • Severe pulmonary disease requiring continuous home oxygen therapy or the continuous or frequent intermittent use of oral steroids or documented severe chronic obstructive pulmonary disease (COPD) with forced expiratory volume in 1 second (FEV1) < 50%.
  • Cardiac surgery, percutaneous coronary intervention, myocardial infarction or unstable angina within the previous 3 months.
  • Transient ischemic attack or stroke within the previous 3 months.
  • Cardiac resynchronization therapy implantation scheduled or performed within 3 months prior to randomization.
  • Primary hemodynamically-significant uncorrected valvular heart disease (obstructive or regurgitant) or any valvular disease expected to require surgery during the trial.
  • Acute myocarditis/pericarditis or other cause of potentially reversible cardiomyopathy (e.g., post-partum cardiomyopathy, tachycardia-induced cardiomyopathy), within the previous 6 months.
  • End-stage (Stage D) heart failure (HF) requiring continuous outpatient intravenous (IV) inotropic therapy, placement of ventricular assist device, listing for cardiac transplantation, or end-of-life care (e.g. hospice care).
  • Pregnancy or of child bearing potential without a negative pregnancy test within 10 days prior to enrollment.
  • Life expectancy < 1 year for diseases unrelated to chronic HF.
  • Enrolled or planning to enroll in another study that may conflict with protocol requirements or confound subject results in this trial.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03745898

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Contact: Emily Kaplan 617-278-0382
Contact: Michelle Reid, MPH

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Sponsors and Collaborators
Brigham and Women's Hospital
Ohio State University
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Responsible Party: Susan Redline, Professor and Senior Physician, Brigham and Women's Hospital Identifier: NCT03745898    
Other Study ID Numbers: U24HL140412-01_UG3
U24HL140412-01 ( U.S. NIH Grant/Contract )
First Posted: November 19, 2018    Key Record Dates
Last Update Posted: February 11, 2021
Last Verified: February 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All relevant deidentified data will be deposited in Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) and the National Sleep Research Resource (NSRR)

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Additional relevant MeSH terms:
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Sleep Apnea Syndromes
Sleep Apnea, Central
Heart Failure
Heart Diseases
Cardiovascular Diseases
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nervous System Diseases