Respiration and Abnormal Sleep in Patients with Congestive Heart Failure

Hanly, Patrick J.; Millar, Tom; Steljes, Darlene G.; Baert, R; Frais, Michael A.; Kryger, Meir H.

doi:10.1378/chest.96.3.480

Cited by 169 publications

(110 citation statements)

References 26 publications

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“…In normal subjects, ventilatory responses both to hypoxia and hypercapnia are reduced in REM sleep compared to NREM [13,19]. It is commonly reported that central apnoeas in heart failure occur predominantly in stage I and stage II NREM sleep [26]. One explanation for this observation is that the normal reduction of ventilatory responsiveness in REM sleep promotes respiratory stability.…”

Section: Discussionmentioning

confidence: 99%

Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea

Wilcox

McNamara²,

Dodd³

et al. 1998

Eur Respir J

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Sleep apnoea is common in patients with heart failure. While most patients have central sleep apnoea (CSA), a minority have obstructive sleep apnoea (OSA). The pathophysiology of CSA is not well understood. We hypothesized that central chemosensitivity would be an important pathophysiological factor in patients with CSA, and not in OSA. The aim of this study was to compare ventilatory responses between patients with CSA and those with OSA.Acute ventilatory responses to eucapnic hypoxia and hyperoxic hypercapnia were measured during wakefulness in 34 patients (33 males and one female, aged 59±8 yrs (mean±sd)), with stable medically-treated left ventricular dysfunction (LVD) and sleep apnoea (18 OSA and 16 CSA).Patients with CSA had a decreased awake end-tidal carbon dioxide tension (4.1± 0.5 kPa), increased ventilatory response to carbon dioxide (0.65±0.43 L·min-1·kPaPCO2-1), and eucapnic hypoxic responses in the normal range (0.6±0.4 L·min-1/% fall in arterial oxygen saturation (Sa,O2)). In contrast, patients with OSA had normal endtidal carbon dioxide tension (4.9±0.5 kPa), and normal ventilatory responses to hypercapnia (0.29±0.16 L·min-1·kPaPCO2-1) and hypoxia (0.5±0.5 L·min-1/% fall inSa,O2).These findings suggest that augmented chemosensitivity to hypercapnia may be an important factor in the pathophysiology of central sleep apnoea in patients with heart failure.

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Section: Discussionmentioning

confidence: 99%

Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea

Wilcox

McNamara²,

Dodd³

et al. 1998

Eur Respir J

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“…1 The episodes of apnea with concomitant hypoxemia and arousal, which are characteristic features of CSR, may be associated with increased sympathetic activity and precipitate ventricular arrhythmias. 2,3 A similar pattern of respiration during the daytime has been recently related to a poor outcome.…”

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confidence: 99%

Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Anker²,

et al. 1999

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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.)

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“…It is remarkable how few women have been found to have CSR, which has been a consistent and long-standing feature of clinical reports in this area [3,4,6,8,16,20]. The ventilatory responses both to hypoxia and hypercapnia are lower in women than men [21] which makes them less likely to hyperventilate and become hypocapneic.…”

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confidence: 77%

“…Although CSR can occur during wakefulness, it is typically found during nonrapid eye movement (NREM) sleep [6]. Central apnoeas alternate with episodes of hyperpnoea with a classic crescendo/decrescendo appearance that reflects the periodic variation in central respiratory drive.…”

mentioning

confidence: 99%

“…Central apnoeas alternate with episodes of hyperpnoea with a classic crescendo/decrescendo appearance that reflects the periodic variation in central respiratory drive. Apnoeas are associated with intermittent hypoxaemia and hyperpnoeas are associated with arousals from sleep that typically occur at the peak of respiratory effort [6]. This fragmentation of sleep leads to excessive daytime sleepiness, which has been observed in patients with CHF and CSR in contrast to heart failure patients without CSR whose daytime alertness was similar to a healthy control group [7].…”

mentioning

confidence: 99%

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Augmented chemosensitivity to hypercapnia: another link in our understanding of the pathogenesis of Cheyne-Stokes respiration

Pj¹

1998

Eur Respir J

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Respiration and Abnormal Sleep in Patients with Congestive Heart Failure

Cited by 169 publications

References 26 publications

Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea

Ventilatory control in patients with sleep apnoea and left ventricular dysfunction: comparison of obstructive and central sleep apnoea

Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Augmented chemosensitivity to hypercapnia: another link in our understanding of the pathogenesis of Cheyne-Stokes respiration

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