(Circulation. 1999;99:1435-1440.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Prognostic Value of Nocturnal Cheyne-Stokes Respiration in Chronic Heart Failure
From the Division of Cardiology (P.A.L., E.B., G.M., P.G.), Division of Pulmonary Disease (A.B., C.F.D.), and Department of Bioengineering (R.C.), Salvatore Maugeri Foundation, IRCCS, Veruno, Italy.
Correspondence to Paola A. Lanfranchi, Division of Cardiology, Centro Medico, 28010 Veruno (NO), Italy. E-mail planfranchi{at}fsm.it
Background—Nocturnal Cheyne-Stokes respiration (CSR) occurs frequently in patients with chronic heart failure (CHF), and it may be associated with sympathetic activation. The aim of the present study was to evaluate whether CSR could affect prognosis in patients with CHF.
Methods and Results—Sixty-two CHF patients with left
ventricular ejection fraction 
35%, in NYHA class II to
III, underwent clinical evaluation, Doppler
echocardiography, ergospirometry,
phenylephrine test, Holter recording, and a sleep
study to evaluate the occurrence of CSR, expressed as percentage of
periodic breathing, and apnea/hypopnea index (AHI) (ie, the number of
apneas and hypopneas per hour of recording). During a mean
follow-up of 28±13 months, 15 patients died of cardiac causes.
Nonsurvivors were in a higher NYHA functional class than survivors
(P<0.001) and had a more depressed left
ventricular ejection fraction (P<0.03), a
shorter deceleration time of early filling (P<0.05),
larger left and right atria (P<0.05 and
P<0.02, respectively) and a lower peak
O2 (P<0.05).
Nonsurvivors also spent a greater percentage of the night in periodic
breathing (P<0.01) with a greater AHI
(P<0.03) and showed lower values of diurnal baroreflex
sensitivity (P<0.05) and of heart rate variability
(sdNN: P<0.01). Multivariate
analysis revealed the AHI (
2, 10.4;
P<0.01), followed by left atrial area
(2, 5.7; P<0.01), as the only
independent and additional predictors of subsequent cardiac death.
Patients at very high risk for fatal outcome could be identified by an
AHI 
30/h and left atria 25 cm2.
Conclusions—The AHI is a powerful independent predictor of poor
prognosis in clinically stable patients with CHF. The presence of an
AHI 30/h adds prognostic information compared with other clinical,
echocardiographic, and autonomic data and identifies
patients at very high risk for subsequent cardiac death.
Key Words: heart failure • sleep • prognosis
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