It has long been established that, for people have chronic hypoxic respiratory failure, supplemental oxygen is beneficial. I have known this for my entire career. And, for many patients, that oxygen needs to be delivered continuously - 24 hours per day, every day.
And this can be very cumbersome for a lot of patients: they can't take a walk in the park, or go shopping, or go out to dinner, without having to lug either a portable concentrator (if they can afford one) or an oxygen tank along with them. In fact, I have seen patients come to the hospital with a hip fracture because they tripped over their oxygen tubing, and a hip fracture can mean death in elderly patients. Worse, I have seen patients come in with terrible facial burns because they continue to smoke with the oxygen flowing (!).
And so I was very intrigued by this study published in the New England Journal of Medicine in September 2024.
The Registry-Based Treatment Duration and Mortality in Long-Term Oxygen Therapy (REDOX) trial was a multicenter, phase 4, randomized, controlled trial evaluating whether long-term oxygen therapy used for 24 hours per day is not superior to therapy used for 15 hours per day. It was based in Sweden.
Patients were randomized to have oxygen for 15 hours per day vs. 24 hours per day. The 15 hour group was told to sleep with the oxygen, and then have it off or 9 hours during the day. The found that the risk of hospitalization or death within 1 year in the 24-hour group was not lower than that in the 15-hour group, meeting the prespecified criteria for nonsuperiority. In addition, the groups did not differ substantially in the incidence of hospitalization for any cause, death from any cause, or adverse events.
This was a great study, and it says that it is probably safe to forgo oxygen for up to 9 hours per day. This should come as great relief to a lot of patients on chronic oxygen therapy, and I see this dramatically improving their quality of life. For me, this study is definitely practice changing.
