Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Prognostic Significance of Fluctuations in End-Expiratory Lung Volume in Hunter-Cheyne-Stokes Breathing

“…Moreover, the magnitude of the chemosensitivity correlates with the severity of sleep-disordered breathing 5 and heart failure. 7 These experimental data are consistent with the findings of Perger et al, 1 in that patients with a negative HCSB pattern had higher NT-proBNP, worse NYHA functional class, and higher left ventricular wall tension.…”

“…Perger et al 1 correctly point out that increases in intrathoracic pressure, consequent to activation of expiratory muscles (responsible for lowering of lung volume below FRC), can have salutatory effects. By effecting a decrease in left ventricular transmural pressure, an elevated intrathoracic pressure augments stroke volume in some (but not all) patients with heart failure.…”

“…In their study, Perger and colleagues 1 report fluctuations in end-expiratory lung volume (EELV) in patients with HunterCheyne-Stokes breathing (HCSB). Episodic alterations in tidal volume have long been recognized as the hallmark of HCSB, although fluctuations in EELV have been recognized only recently.…”

“…1 We also reason that augmented inspiratory drive leading to hyperventilation following central apneas will lower arterial CO 2 pressure significantly; hypocapnia predisposes to the inhibition of the post-inspiratory inspiratory muscle activity, leaving expiratory muscle activity unopposed and, thus, facilitating reduction in EELV. Further systematic physiological studies using EMG of various groups of muscles and intrathoracic pressure are required to delineate the relative contribution of different muscle groups.…”

“…1 In the study by Perger et al, 1 quantitative volumetric measurements were not obtained and assignment to one of the groups was based on directional alterations in EELV. Perger et al 1 did not obtain robust data to demonstrate what constituted resting FRC in each individual patient, on which all subsequent calculations were predicated.…”