Cheyne-Stokes Respiration and Prognosis in Modern-Treated Congestive Heart Failure

Abstract

In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 ± 18 months. Mean age was 62 ± 13 years and the mean ejection fraction was 25 ± 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index[5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox's proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome.

Prognostic Impact of Central Sleep Apnea in Patients With Heart Failure

“…13e26 Eight earlier studies 13,16,17,19,20,23,25,26 reported a higher mortality in patients with CSA, although 6 others failed to demonstrate an increased mortality in patients with CSA. 14,15,18,21,22,24 Most of those studies had $1 of the following limitations: small patient populations with few end points during follow-up, retrospective study design, use of polygraphy rather than polysomnography as criterion standard to detect CSA, no uniform use of ventilation, and lack of multivariate analysis to adjust for confounding variables. The 1st small study designed to specifically determine the impact of CSA on mortality in HF was reported by Hanly et al in 1996.…”

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

“…Cardiac resynchronization therapy has also been shown to improve sleep quality, QoL as well as cardiac pump function and patients’ outcome. Therefore, this albeit very expensive therapy should be evaluated in patients with severe heart failure associated with ventricular asynchrony due to conduction abnormalities [69]. If cardiac therapy fails to reverse CSR, directly influencing the respiratory controller to smooth periodic breathing arises as the goal of therapy [9,10,70].…”

Rostral ventrolateral medullary catecholaminergic neurones mediate irregular breathing pattern in volume overload heart failure rats

“…; Hagenah et al . ). In experimental HF, we found that disordered breathing patterns under normoxia were markedly reduced after ablation of RVLM‐C1 neurones (Figs and , and Table ).…”