Implications of Cheyne‐Stokes Breathing in Advanced Systolic Heart Failure

Abstract

Background: Cheyne-Stokes breathing (CSB) has been associated with heart failure (HF) patients for many years; however, its true prevalence and its prognostic implications are still obscure. Hypothesis: The goal of this study was to investigate the prevalence and the possible prognostic implications of nocturnal CSB in advanced heart failure patients. Methods: We performed single night full polysomonography ambulatory sleep studies in 71 HF patients. We analyzed the patients' sleep studies, clinical and laboratory data, and 6 month mortality. Results: A total of 71 chronic systolic HF patients were analyzed, 60 males, 11 females, age 65±13 years. Mean left ventricular ejection fraction was 27%±11%. Short episodes of CSB (at least 3 min duration) were present in all patients,and mean CSB duration was 1 hour. CSB duration was associatedsignificantly with both high serum levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) as well as with 6 month mortality. Log CSB time had a significant correlation with log NT-proBNP (r = 0.5, P<.0001). Based on median CSB duration, the Kaplan-Meier survival curve analysis showed significant association with 6 month mortality (P = .03). Conclusions: CSB prevalence in advanced HF patients is higher than previously reported and is associated with increased serum levels of NT-proBNP and higher 6 month mortality. IntroductionCheyne-Stokes breathing (CSB) has been associated with heart failure for more than 2 centuries and yet its incidence and clinical implications are still being debated. Therefore, we conducted ambulatory sleep studies in 71 advanced systolic heart failure (HF) patients in order to assess the prevalence and consequences of CSB. To evaluate the possible prognostic implications of CSB in HF, we analyzed sleep study results, clinical data, laboratory parameters, and followed patient mortality for 6 months.

Long-term assessment of nocturnal Cheyne-Stokes respiration in patients with heart failure

“…The two signals are analyzed by means of an innovative CSR algorithm (WideMed, Herzliya, Israel), which enabled us to measure the Cheyne-Stokes episodes and calculate their characteristics via a mathematical model based on the saturation signal. The validity and reliability of the CSR using the defined mathematical algorithm implemented in the automatic analysis have been demonstrated in previous BMI, body mass index; LVEF, left ventricular ejection fraction; NYHA class, New York Heart Association (Functional Classification); ACEI/ ARB, angiotensin-converting enzyme inhibitors/angiotensin ii receptor blockers publications by our group [13,15]. The analysis of the periodic breathing patterns of CSR receives the variations in the oxygen saturation signal.…”

“…CSR will be positive once the analysis shows periodic events meaning similar distance between the events, as well as similar events pattern. In this case, the average of all periodic events is given as CL [1,[13][14][15]. To test this hypothesis, we followed HF patients, either continuously or periodically, in order to monitor the presence of CSR and to analyze its CL characteristics and its changes over time.…”

Congestive Heart Failure and Central Sleep Apnea

“…(14,16) CSR is also not limited to systolic heart failure; CSR is common in patients with symptomatic heart failure with preserved ejection fraction (17) (diastolic dysfunction), and is also common in patients with asymptomatic systolic dysfunction (18). Additional risk factors for CSR include male gender, older age, the presence of atrial fibrillation, nocturnal ventricular arrhythmias, low arterial PCO 2 (PaCO 2 ), dyspnea with minimal exertion (NYHA class ≥II), nocturnal dyspnea, very low ejection fraction (EF<20%), left atrial enlargement, and high NT-proBNP (5,10,12,14,15,19,20).…”

“…(6) Despite advances in the treatment of congestive heart failure (e.g. beta-blockade, spironolactone), untreated CSR remains highly prevalent during sleep and retains its association with increased morbidity and mortality independent of heart failure severity (7)(8)(9)(10).…”

Congestive Heart Failure and Central Sleep Apnea

“…(6) Despite advances in the treatment of congestive heart failure (e.g. beta-blockade, spironolactone), untreated CSR remains highly prevalent during sleep and retains its association with increased morbidity and mortality independent of heart failure severity (7–10). (Boxes 1–4)…”