Clinical Significance of the Presence of Oscillatory Breathing Both at Rest and During Exercise in Cardiac Patients

Abstract

SummaryCardiac patients often experience nocturnal and daytime oscillatory breathing (OB). OB noted at rest sometimes becomes unclear or even disappears during exercise. We evaluated the physiological significance of OB by comparing the clinical characteristics of cardiac patients who manifested OB only at rest (group A), only during exercise (group B), and both at rest and during exercise (group C). Among 3,432 cardiac patients who underwent cardiopulmonary exercise testing (CPX), 114, 94, and 65 patients were identified as group A, B, and C, respectively. Left ventricular ejection function was 57 ± 17% in group A, 49 ± 20% in group B, and 41 ± 21% in group C (P < 0.05 for all comparisons among the 3 groups). The level of brain natriuretic peptide (BNP) was significantly higher in group C than in groups A and B. The peak VO2 was lower and the VE-VCO2 slope was higher in groups B and C than in group A.The present findings suggest that cardiac function is more impaired in cardiac patients who manifest OB both at rest and during exercise than in cardiac patients who manifest OB only at rest or only during exercise. (Int Heart J 2018; 59: 713-718)

Is It Possible to Distinguish Patients with Terminal Stage of Heart Failure by Analyzing Their Breathing Patterns?

“…20) Although the pattern of breathing is altered, it is difficult to conceptualize the difference analyzed during a physical examination. As shown in p.714, Figure 1, breathing can be clearly divided into three patterns in cardiovascular patients analyzed by CPX.…”

“…As shown in p.714, Figure 1, breathing can be clearly divided into three patterns in cardiovascular patients analyzed by CPX. 20) The details of the mechanisms and differences in oscillatory breathing at rest and during exercise are unknown; however, the prolonged circulation time is a significant determinant of oscillatory breathing, and the cycle length of oscillatory breathing is related to the circulation time and closely linked to the severity of heart failure. 20) According to a combination of mathematical modeling and direct measurement, daytime oscillatory breathing in heart failure is closely related to chemoreflex hypersensitivity and reduced stability that predicts mortality in patients with advanced heart failure.…”

“…20) The details of the mechanisms and differences in oscillatory breathing at rest and during exercise are unknown; however, the prolonged circulation time is a significant determinant of oscillatory breathing, and the cycle length of oscillatory breathing is related to the circulation time and closely linked to the severity of heart failure. 20) According to a combination of mathematical modeling and direct measurement, daytime oscillatory breathing in heart failure is closely related to chemoreflex hypersensitivity and reduced stability that predicts mortality in patients with advanced heart failure. 21) Himi, et al concluded that cardiac function is more impaired in cardiac patients who manifest oscillatory breathing at rest and during exercise than in those who manifest oscillatory breathing only at rest or only during exercise.…”

“…21) Himi, et al concluded that cardiac function is more impaired in cardiac patients who manifest oscillatory breathing at rest and during exercise than in those who manifest oscillatory breathing only at rest or only during exercise. 20) The frequent occurrence of oscillatory breathing may be a more important indicator for severe heart failure, regardless of during exercise or at rest.…”