Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Abstract

Background-Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity. Methods and Results-To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L ⅐ min Ϫ1 ⅐ %SaO 2 Ϫ1 , PϽ0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (Pϭ0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, PϽ0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (Pϭ0.04). Conclusions-An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing. (Circulation. 1999;100:2418-2424.)

Central Sleep Apnea in Left Ventricular Dysfunction

“…Augmented peripheral chemosensitivity may contribute to periodic breathing in awake heart failure patients, as well as to CSA and to autonomic dysfunction. 32 Therefore, it is conceivable that chemoreflex-baroreflex interactions may be implicated in the genesis of abnormalities in breathing control leading to CSA in patients with LV dysfunction.…”

Sleep Apnea and Heart Failure

“…The presence of periodic breathing, very low-frequency oscillations in heart rate, and enhanced peripheral chemoreceptor sensitivity in patients with HF are together associated with a higher mortality rate. 31,34 …”

SERVE-HF - Was Treating a Central Neurological Disturbance of Breathing Control by a Mechanism Initially Designed to Keep Open an Obstructed Airway Always Doomed to Fail?

“…We found that both were surprisingly common in CHF patients and both were associated with augmented chemoreflex sensitivity, so much so that, not only was there an extremely high correlation between the power of the oscillatory pattern of breathing and chemosensitivity 2 , but that switching off chemoreflex firing with inspired oxygen, rapidly and reproducibly abolished the oscillatory breathing pattern. We and close colleagues also later showed even in normals we could mimic periodic breathing and even generate a pattern close to Cheyne-Stokes respiration by manoeuvres such as voluntary hyperventilation followed by rest, as a way to mimic virtually unopposed chemoreflex control of the circulatory and respiratory rhythms.…”