Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration.

STUDY OBJECTIVE To determine whether patients with congestive heart failure who develop Cheyne-Stokes respiration (CSR) during sleep experience excessive daytime sleepiness. This was addressed by comparing sleep quality and daytime sleepiness in three groups: patients with CHF and CSR during sleep (CSR group), patients with CHF without CSR (CHF group), and healthy control subjects (control group). DESIGN Single-blind, cross-sectional study. SETTING Patients referred by cardiologists and control subjects recruited from the general community. PATIENTS Twenty-three men: 7 in the CSR group, 7 in the CHF group, and 9 in the control group. MEASUREMENTS Each subject had an overnight sleep study and an assessment of sleepiness the following day. RESULTS The three groups were a similar age: CSR, 68 +/- 5 years; CHF, 62 +/- 4 years; and control, 65 +/- 4 years; and left ventricular ejection fraction was the same in patients with CSR (20 +/- 1.5%) and CHF (23 +/- 5%). Sleep latency was significantly shorter in patients with CSR (4 +/- 1.1 min) than patients with CHF (11.3 +/- 4.8 min) and healthy controls (12.4 +/- 1.9 min) and was within the diagnostic range of severe sleepiness. Patients with CSR had significantly more stage 1 and 2 non-rapid eye movement (NREM) sleep (CSR, 83 +/- 7; CHF, 64 +/- 9; control, 63 +/- 9% total sleep time), less REM sleep (CSR, 10 +/- 3; CHF, 22 +/- 8; control, 22 +/- 7% total sleep time), and a higher frequency of arousals from sleep (CSR, 30 +/- 16; CHF, 18 +/- 15; control, 10 +/- 2/h of sleep); 66% of arousals were associated with CSR. Regression analysis revealed that sleep latency was inversely related to the amount of stage 1 and 2 NREM sleep (r = -0.67), arousal frequency (r = -0.46), and the apnea-hypopnea index (r = -0.63) and was positively correlated with the amount of slow-wave sleep (r = 0.45) and REM sleep (r = 0.56) and the mean oxygen saturation during sleep (r = 0.50). CONCLUSIONS Patients with CHF who develop CSR experience excessive daytime sleepiness due to sleep disruption. This should be considered the clinical evaluation of these patients' daytime complaints.

[1]  T. D. Bradley,et al.  Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure. , 1989, The American review of respiratory disease.

[2]  Kryger Mh,et al.  Management of obstructive sleep apnea. , 1992 .

[3]  M. Kryger,et al.  Respiration and abnormal sleep in patients with congestive heart failure. , 1989, Chest.

[4]  M. Thorpy.  The clinical use of the Multiple Sleep Latency Test. The Standards of Practice Committee of the American Sleep Disorders Association. , 1992, Sleep.

[5]  P. Hanly,et al.  Pathogenesis of Cheyne-Stokes respiration in patients with congestive heart failure. Relationship to arterial PCO2. , 1993, Chest.

[6]  M. Carskadon,et al.  Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects. , 1978, Electroencephalography and clinical neurophysiology.

[7]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[8]  L. Findley,et al.  Automobile accidents involving patients with obstructive sleep apnea. , 1988, The American review of respiratory disease.

[9]  T. R. Harrison,et al.  CONGESTIVE HEART FAILURE: XX. CHEYNE-STOKES RESPIRATION AS THE CAUSE OF PAROXYSMAL DYSPNEA AT THE ONSET OF SLEEP , 1934 .

[10]  M. Carskadon,et al.  Cumulative effects of sleep restriction on daytime sleepiness. , 1981, Psychophysiology.

[11]  M. Kryger,et al.  Review: sleep in heart failure. , 1993, Sleep.

[12]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[13]  S. Javaheri,et al.  Cheyne-Stokes respiration presenting as sleep apnea syndrome. Clinical and polysomnographic features. , 1990, The American review of respiratory disease.

[14]  W C Dement,et al.  The sleep apnea syndromes. , 1976, Annual review of medicine.

[15]  I. Karacan,et al.  Sleep Disorders: Diagnosis and Treatment , 1999 .

[16]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[17]  H. Moldofsky,et al.  Evaluation of daytime sleepiness. , 1992, Clinics in chest medicine.

[18]  W. Dement,et al.  Self-reported excessive daytime somnolence and impaired respiration in sleep. , 1986, Chest.

[19]  Bradley Td.  Right and left ventricular functional impairment and sleep apnea. , 1992, Clinics in chest medicine.

[20]  T. Roth,et al.  Predictors of objective level of daytime sleepiness in patients with sleep-related breathing disorders. , 1989, Chest.

[21]  B Roth,et al.  Life Effects of Narcolepsy in 180 Patients from North America, Asia and Europe Compared to Matched Controls , 1981, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[22]  M. Kryger,et al.  Principles and Practice of Sleep Medicine , 1989 .

[23]  M. Kryger,et al.  The effect of oxygen on respiration and sleep in patients with congestive heart failure. , 1989, Annals of internal medicine.

[24]  L C Johnson,et al.  Subjective and objective measures of sleepiness: effect of benzodiazepine and caffeine on their relationship. , 1991, Psychophysiology.