Cheyne-Stokes Respiration in Chronic Heart Failure

Abstract

Sleep-disordered breathing (SDB) with predominant obstructive or central sleep apnea (OSA/CSA) with CheyneStokes respiration (CSR) is a common, but underestimated and underappreciated, comorbidity in patients with heart failure (HF). Regardless of the type of HF (systolic or diastolic) or its etiology (ischemic, non-ischemic, valvular etc), the prevalence of SDB is remarkably high in this patient group, at 70-76%. Even more so in HF than in the general population, OSA and CSA in particular are independently associated with an impaired prognosis. This review details the pathophysiology of CSA-CSR in HF, highlights the challenges and tools available for diagnosis, explains the concept of adaptive servoventilation (ASV) therapy, and summarizes the existing literature on the use of ASV therapy in HF patients in general and HF with reduced ejection fraction in particular. (Circ J 2012; 76: 2305 -2317 Key Words: Adaptive servoventilation; Cheyne-Stokes respiration; Heart failure; Sleep-disordered breathing Figure 1. Scheme of the relative prevalence and importance of obstructive (OSA) and central sleep apnea (CSA) according to heart failure severity. With increasing impairment in cardiac function there is an increase in CSA prevalence. NYHA, New York Heart Association class.

Sleep‐disordered breathing in heart failure: facts and numbers

“…This is particularly true in patients with symptomatic HF, in whom 50–70% of patients are affected by sleep‐disordered breathing 21, 36, 37. Whilst patients with less symptomatic status more often present with OSA, CSA is becoming more prevalent in advanced stages of HF, that is, in patients in New York Heart Association classes III and IV 22. Even more problematic is the fact that typical signs of sleep‐disordered breathing may be absent in patients with HF or they may overlap with symptoms of HF itself, therefore rendering the differential diagnosis difficult.…”

“…In patients with HF, the prevalence is significantly higher 21, 22, 47, 48. In one study, patients with chronic HF (New York Heart Association ≥II or left‐ventricular ejection fraction ≤40%) 40% were diagnosed with CSA and 35% with OSA 21…”

“…Central sleep apnoea is a primary comorbidity in HF,1, 3, 5, 15, 16, 17, 18, 20, 23 increasing in prevalence with deteriorating cardiac function 21, 22, 48. Chronic HF is recognized as an independent risk factor for the development of CSA 1, 5.…”

“…The patency of the respiratory tract is functional, but the ventilatory effort, the essential central trigger for breathing, is intermittently disrupted. This malfunction can originate from a variety of neurological diseases11, 12, 13, 14 or HF 1, 3, 5, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24. In HF, the accepted hypothesis is that pulmonary congestion, (which is further aggravated in a horizontal sleeping position) due to a higher left ventricular filling pressure, activates lung vagal irritant receptors causing hyperventilation and hypocapnia 3, 5, 19.…”

Respiratory Effects of Adaptive Servoventilation Therapy in Patients with Heart Failure and Cheyne-Stokes Respiration Compared to Healthy Volunteers

“…Whereas obstructive sleep apnea seems to be a risk factor for the development of HF [2], central sleep apnea (CSA) with a Cheyne-Stokes respiration (CSR) pattern seems to mirror cardiac function in these patients [3]. Therefore, CSR is seen more often when HF is advanced [3]. …”