Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation

Leite, João Jorge; Mansur, Alfredo José; Freitas, Humberto Felício Gonçalves de; Chizola, Paulo R.; Bocchi, Edimar Alcides; Filho, Mário Terra; Neder, J. Alberto; Lorenzi-Filho, Geraldo

doi:10.1016/s0735-1097(03)00460-1

Cited by 176 publications

(191 citation statements)

References 31 publications

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“…Periodic fluctuations in V9O 2 and V9CO 2 at rest and at low workrates may be observed in patients with CHF, particularly in the more severe cases [161][162][163]. The cause is unclear but might reflect periodic fluctuations in pulmonary perfusion and/or ventilation.…”

Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

533

382

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Ventilatory Abnormalitiesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

533

382

View full text Add to dashboard Cite

show abstract

“…Some patients with heart failure will demonstrate a periodic breathing pattern even during wakefulness and exercise. 38,39 In this case, a polysomnogram is often helpful to exclude concurrent obstructive apnea and to guide treatment for the nocturnal periodic breathing. Schematic outlining possible mechanisms underlying development of CSA and the possible feedback from CSA resulting in exacerbation of heart failure.…”

Section: Central Sleep Apneamentioning

confidence: 99%

“…Compared with heart failure patients without CSA/ CSR, heart failure patients with CSA/CSR were more likely to be older (Ͼ60 years of age) and male and to have atrial fibrillation, lower arterial PCO 2 (Յ38 mm Hg), 47 and heightened sensitivity to CO 2 . 36 Oscillatory breathing patterns evident in heart failure patients during wakefulness 341 and exercise 38,342 also may predict both the presence of CSA and poorer prognosis. 39 Thus, in patients with heart failure and Ն1 of these characteristics, a diagnosis of CSA/CSR should be strongly considered, and a careful sleep history should be obtained.…”

Section: Clinical Presentationmentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

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Section: Introductionmentioning

confidence: 99%

“…2 Disorders in the central control of breathing are a key factor in altered daily sleep-wake rhythm and are also an independent predictor for premature death. 3,4 Although it is known that cardiovascular diseases are closely related to circadian rhythm, 5 the relationship among changes in circadian rhythm, sleep disorders and cardiovascular diseases has not yet been elucidated.It has been reported that long-term treatment with b-receptorblocking substances (b-blockers) improves hypertension and CHF. bBlockers also reduce the inappropriate increase of ventilation during exercise and alleviate central breathing disorders during wakefulness.…”

mentioning

confidence: 99%

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

et al. 2010

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There is a deep relationship between impaired circadian rhythm and hypertension. However, the detailed mechanisms between the daily sleep-wake rhythm and cardiovascular disorders have not yet been elucidated. To clarify the mechanism, we examined salt-sensitive Dahl rats that were fed normal chow (n¼10), high-salt chow (n¼10) and high-salt chow with bisoprolol (n¼10). Simultaneous electroencephalogram, electromyogram and locomotor activity were examined to analyze the sleep-wake state. We also examined heart rate, blood pressure and echocardiographic findings to verify the presence of hypertension. Hypertension with impaired ventricular contraction was observed in the rats with high-salt-chow consumption whereas normal-chow rats did not show these disorders. Although rats with the normal diet showed a standard daily rhythm with normal rapid eye movement (REM) sleep duration and locomotor activity, the high-salt-diet group exhibited an impaired daily rhythm with suppressed REM sleep and significant abnormal locomotor activity. Bisoprolol significantly improved the daily sleep-wake rhythm and locomotor activity. We showed that an impaired daily rhythm was closely related to the development of hypertension. Keywords: b-blocker; daily rhythm; locomotor activity INTRODUCTION It is well known that there is a deep relationship between sleep disorders and cardiovascular diseases such as hypertension and congestive heart failure (CHF). The fact that patients with advanced CHF induced by hypertension frequently suffer from central breathing disorders 1 suggests that CHF is causally related to alterations in the central control of breathing, resulting in Cheyne-Stokes respiration during sleep. 2 Disorders in the central control of breathing are a key factor in altered daily sleep-wake rhythm and are also an independent predictor for premature death. 3,4 Although it is known that cardiovascular diseases are closely related to circadian rhythm, 5 the relationship among changes in circadian rhythm, sleep disorders and cardiovascular diseases has not yet been elucidated.It has been reported that long-term treatment with b-receptorblocking substances (b-blockers) improves hypertension and CHF. bBlockers also reduce the inappropriate increase of ventilation during exercise and alleviate central breathing disorders during wakefulness. 6,7 These positive effects result in improved exercise capacity and slower progression of underlying hypertension and CHF. However, little is known about the effects of b-blocker treatment on sleep

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Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation

Abstract: Exercise-related periodic breathing independently predicts cardiac mortality in CHF patients considered for heart transplantation.

Cited by 176 publications

References 31 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Sleep Apnea and Cardiovascular Disease

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

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