(Circulation. 1999;100:2418.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure
Clinical Implications and Role of Augmented Peripheral Chemosensitivity
From Cardiac Medicine (P.P., S.D.A., T.P.C., D.F., P.A.P.-W., A.J.S.C., M.P.), Imperial College, National Heart & Lung Institute, London, UK; the Cardiology Department (P.P., W.B.), Clinical Military Hospital, Wroclaw, Poland; and Franz-Volhard-Klinik (S.D.A.), Charité, Campus Berlin-Buch, at Max-Delbrück-Centrum, Berlin, Germany.
Correspondence to Piotr Ponikowski, MD, PhD, Cardiac Medicine, National Heart & Lung Institute, Dovehouse St, London SW3 6LY, UK.
Background—Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity.
Methods and Results—To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L · min-1 · %SaO2-1, P<0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (P=0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, P<0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (P=0.04).
Conclusions—An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing.
Key Words: respiration • heart failure • receptors
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