Quantitative General Theory for Periodic Breathing in Chronic Heart Failure and its Clinical Implications

Francis, Dárrel P.; Willson, Keith; Davies, L. Ceri; Coats, Andrew J.S.; Piepoli, Massimo F

doi:10.1161/01.cir.102.18.2214

Cited by 168 publications

(150 citation statements)

References 39 publications

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“…The cyclelength in our patients with severe CSA (48 s), although higher than the cycle-length reported in patients with idiopathic CSA and normal ventricular function (35 s), 13 is significantly lower than the cycle-length reported in patients with CSA and heart failure (69 s). 13,24 In our present study, the cycle-length was similar for all patients, thus confirming that the degree of hemodynamic dysfunction reflected by this index is equally present in these 3 groups and, therefore, is not the primary factor inducing CSA in our patients.…”

Section: Discussionsupporting

confidence: 82%

“…In patients with overt heart failure, CSA correlated with pulmonary capillary wedge pressure, as measured by invasive 22 and noninvasive 23,24 approaches. In our present study of patients with LV dysfunction without overt heart failure, the presence and severity of CSA was not associated with increased ventricular impairment or hemodynamic indices of increased filling pressure (Figure 2).…”

Section: Discussionmentioning

confidence: 92%

“…26 Periodic breathing has been explained as a selfsustaining oscillation due to the loss of stability in the closed-loop chemical control of ventilation 26 due, in heart failure, to an enhanced loop gain (hyperventilation), a slow circulation time between lungs and chemoreceptors, and inability to adjust to perturbations in the blood gases. 24 Heart failure patients with CSA-Cheyne-Stokes respiration (CSR) tend to hyperventilate. 27 This tendency to hyperventilate has been attributed in part to the afferent stimulation from pulmonary venous congestion.…”

Section: Discussionmentioning

confidence: 99%

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Central Sleep Apnea in Left Ventricular Dysfunction

et al. 2003

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Background— The prevalence and characteristics of sleep-disordered breathing in patients with asymptomatic left ventricular (LV) dysfunction are unknown. Therefore, we evaluated the prevalence of sleep-disordered breathing in patients with LV dysfunction without overt heart failure and tested the hypothesis that sleep-disordered breathing is linked to greater hemodynamic and autonomic impairment. Methods and Results— We studied 47 patients with LV ejection fractions ≤40% without any history of heart failure. Central sleep apnea (CSA), as defined by an apnea-hypopnea index ≥15/h, was present in 26 patients (55%), 17 (36%) of whom had severe CSA (apnea-hypopnea index ≥30/h). Obstructive sleep apnea was evident in 5 patients (11%). The prevalence and severity of CSA were higher in patients with ischemic cardiomyopathy than in patients with nonischemic cardiomyopathy ( P <0.05). Exercise tolerance and echocardiographic indices of systolic and diastolic function were similar in patients without CSA, with mild CSA, and with severe CSA. Heart rate variability was markedly depressed in patients with CSA ( P <0.05). Patients with severe CSA also had a higher incidence of nonsustained ventricular tachycardia ( P =0.05). Conclusions— CSA is highly prevalent in patients with asymptomatic LV dysfunction. The severity of CSA may not be related to the severity of hemodynamic impairment. Severe CSA is associated with impaired cardiac autonomic control and with increased cardiac arrhythmias.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Central Sleep Apnea in Left Ventricular Dysfunction

et al. 2003

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“…Although CSB has been known for many years to be associated with HF, 8,9 its mechanism, prognostic implications, and possible therapies are still controversial. [10][11][12][13] Although in this current study we concentrated solely on a specific pattern of central sleep disturbance, namely CSB, other forms of sleep apnea have been identified in HF patients, including obstructive and central apneas. 6,12,14 A few studies of HF patients suggested that high AHI, obstructive, and central apneas are all associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

Implications of Cheyne‐Stokes Breathing in Advanced Systolic Heart Failure

Amir

Reisfeld²,

Sberro³

et al. 2010

Clinical Cardiology

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Background: Cheyne-Stokes breathing (CSB) has been associated with heart failure (HF) patients for many years; however, its true prevalence and its prognostic implications are still obscure. Hypothesis: The goal of this study was to investigate the prevalence and the possible prognostic implications of nocturnal CSB in advanced heart failure patients. Methods: We performed single night full polysomonography ambulatory sleep studies in 71 HF patients. We analyzed the patients' sleep studies, clinical and laboratory data, and 6 month mortality. Results: A total of 71 chronic systolic HF patients were analyzed, 60 males, 11 females, age 65±13 years. Mean left ventricular ejection fraction was 27%±11%. Short episodes of CSB (at least 3 min duration) were present in all patients,and mean CSB duration was 1 hour. CSB duration was associatedsignificantly with both high serum levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) as well as with 6 month mortality. Log CSB time had a significant correlation with log NT-proBNP (r = 0.5, P<.0001). Based on median CSB duration, the Kaplan-Meier survival curve analysis showed significant association with 6 month mortality (P = .03). Conclusions: CSB prevalence in advanced HF patients is higher than previously reported and is associated with increased serum levels of NT-proBNP and higher 6 month mortality. IntroductionCheyne-Stokes breathing (CSB) has been associated with heart failure for more than 2 centuries and yet its incidence and clinical implications are still being debated. Therefore, we conducted ambulatory sleep studies in 71 advanced systolic heart failure (HF) patients in order to assess the prevalence and consequences of CSB. To evaluate the possible prognostic implications of CSB in HF, we analyzed sleep study results, clinical data, laboratory parameters, and followed patient mortality for 6 months.

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“…A variety of models of the cardiovascular and respiratory systems have been constructed [8,9,10,11,16,18,20,24,26,28,31,39,42]. The models that are most related to our research mathematically use…”

mentioning

confidence: 99%