Cheyne-Stokes respiration in patients hospitalised for heart failure

BackgroundPrevious studies showing a strong relationship between Cheyne-Stokes respiration and the severity of left ventricular systolic dysfunction have usually been done in selected patient populations with lower age and a higher proportion of males than the "typical" in-hospital patient with heart failure. The purpose of the present study was test the strength of this relationship in unselected patients admitted to hospital due to decompensated chronic heart failure.MethodsWe evaluated 191 patients (32% women), mean age 73 years, ready for discharge from the heart failure unit in the University Hospital of Malmö, Sweden. The patients underwent echocardiography for determination of left ventricular ejection fraction and left ventricular inner diastolic diameter. A respiratory investigation during sleep was performed the last night before discharge.ResultsWe found that 66% of the patients had Cheyne-Stokes respiration more than 10% of the total recording time. Only 7 (3.6%) of the patients had predominantly obstructive apnoeas. There was a significant but very weak relationship between left ventricular ejection fraction and left ventricular inner diastolic diameter on one hand and Cheyne-Stokes respiration on the other. Age was a stronger determinant of Cheyne-Stokes respiration than any of the cardiac or other clinical variables.ConclusionAlthough presence of Cheyne-Stokes respiration indicates left ventricular dysfunction, its severity seems only weakly related to the severity of heart failure. Age was found to be a stronger determinant, which may reflect the underlying age-dependency found also in healthy subjects. Due to age restrictions or other selection criteria, the importance of age may have been underestimated in many previous studies on factors associated with Cheyne-Stokes respiration.

[1]  P. Hanly,et al.  Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. , 1995, Chest.

[2]  Daniel J Buysse,et al.  Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research , 2000 .

[3]  A. Staniforth,et al.  Nocturnal desaturation in patients with stable heart failure , 1998, Heart.

[4]  S. Javaheri,et al.  Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. , 1998, Circulation.

[5]  E. Bixler,et al.  Effects of age on sleep apnea in men: I. Prevalence and severity. , 1998, American journal of respiratory and critical care medicine.

[6]  Daniel J Buysse,et al.  Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. , 1999, Sleep.

[7]  C. Alex,et al.  Upper airway occlusion during sleep in patients with Cheyne-Stokes respiration. , 1986, The American review of respiratory disease.

[8]  R. Maestri,et al.  Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. , 1999, The American journal of cardiology.

[9]  S. Javaheri,et al.  Occult Sleep-Disordered Breathing in Stable Congestive Heart Failure , 1995, Annals of Internal Medicine.

[10]  B. Rappaport,et al.  Verification of Sleep Apnea Using a Portable Sleep Apnea Screening Device , 1990, Southern medical journal.

[11]  T. D. Bradley,et al.  Overnight Shift From Obstructive to Central Apneas in Patients With Heart Failure: Role of Pco2 and Circulatory Delay , 2001, Circulation.

[12]  P. Friedman,et al.  Comparison of patients with central sleep apnea. With and without Cheyne-Stokes respiration. , 1994, Chest.

[13]  S. Redline,et al.  Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. , 1991, Chest.

[14]  M. Alam,et al.  Haemodynamic significance of the atrioventricular plane displacement in patients with coronary artery disease. , 1992, European heart journal.

[15]  S. Andreas,et al.  Cheyne-Stokes respiration and prognosis in congestive heart failure. , 1996, The American journal of cardiology.

[16]  J S Floras,et al.  Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. , 1999, American journal of respiratory and critical care medicine.

[17]  N. Bayley,et al.  Failure , 1890, The Hospital.

[18]  R Colombo,et al.  Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. , 1999, Circulation.

[19]  Peter P. Liu,et al.  Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. , 1997, American journal of respiratory and critical care medicine.

[20]  E. Atkinson,et al.  Nocturnal dyspnea and atrial fibrillation predict Cheyne-Stokes respirations in patients with congestive heart failure. , 1995, Archives of internal medicine.

[21]  B. Wuyam,et al.  High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months. , 1999, European heart journal.

[22]  P. Hanly,et al.  Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure. , 1996, American journal of respiratory and critical care medicine.

[23]  L. Erhardt,et al.  Left ventricular atrioventricular plane displacement: an echocardiographic technique for rapid assessment of prognosis in heart failure. , 1997, Heart.

[24]  T. Welte,et al.  Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature , 2002, Thorax.

[25]  M. Alam,et al.  Longitudinal systolic shortening of the left ventricle: an echocardiographic study in subjects with and without preserved global function. , 1992, Clinical physiology.

[26]  Guidelines for the diagnosis of heart failure , 2022 .