The Centers for Medicare & Medicaid Services (CMS) currently covers nocturnal oxygen for patients with COPD whose oxygen saturation is < 88% for more than 5 nonconsecutive minutes during sleep. As a practicing pulmonary and sleep physician, I've always considered this a very low bar to meet. Studies in elderly patients (age > 60 years) without COPD show a median oxygen nadir of 88%-89% during sleep, which implies that a substantial number of patients with COPD will qualify for nocturnal oxygen if we screen them with overnight oximetry.
In 2018, a review published in the American Journal of Respiratory and Critical Care Medicine recommended against ordering supplemental nocturnal oxygen for patients with COPD who meet CMS criteria. They noted that three small, randomized trials failed to show any meaningful benefit from nocturnal oxygen supplementation. The review authors concluded that they were anxiously awaiting publication of the larger randomized controlled International Nocturnal Oxygen (INOX) trial, investigating the efficacy of nocturnal oxygen supplementation for patients with COPD.
Well, the INOX trial was just published. A short summary? The findings were negativeOver a period of 4 years, providing nocturnal oxygen to patients with saturation < 90% for at least 30% of total sleep time resulted in no tangible benefits.
