(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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D. Mansfield, D. M. Kaye, H. Brunner La Rocca, P. Solin, M. D. Esler, and M. T. Naughton Raised Sympathetic Nerve Activity in Heart Failure and Central Sleep Apnea Is Due to Heart Failure Severity Circulation, March 18, 2003; 107(10): 1396 - 1400. [Abstract] [Full Text] [PDF]
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P. A. Lanfranchi, V. K. Somers, A. Braghiroli, U. Corra, E. Eleuteri, and P. Giannuzzi Central Sleep Apnea in Left Ventricular Dysfunction: Prevalence and Implications for Arrhythmic Risk Circulation, February 11, 2003; 107(5): 727 - 732. [Abstract] [Full Text] [PDF]
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S. Andreas, C. Bingeli, P. Mohacsi, T. F. Luscher, and G. Noll Nasal Oxygen and Muscle Sympathetic Nerve Activity in Heart Failure Chest, February 1, 2003; 123(2): 366 - 371. [Abstract] [Full Text] [PDF]
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A. Koike, N. Shimizu, A. Tajima, T. Aizawa, L. T. Fu, H. Watanabe, and H. Itoh Relation Between Oscillatory Ventilation at Rest Before Cardiopulmonary Exercise Testing and Prognosis in Patients With Left Ventricular Dysfunction Chest, February 1, 2003; 123(2): 372 - 379. [Abstract] [Full Text] [PDF]
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T. Kohnlein, T. Welte, L.B. Tan, and M.W. Elliott Assisted ventilation for heart failure patients with Cheyne-Stokes respiration Eur. Respir. J., October 1, 2002; 20(4): 934 - 941. [Abstract] [Full Text] [PDF]
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A. A. El-Solh, E. Bozkanat, J. Mador, and B. J. B. Grant Association Between Plasma Endothelin-1 Levels and Cheyne-Stokes Respiration in Patients With Congestive Heart Failure* Chest, June 1, 2002; 121(6): 1928 - 1934. [Abstract] [Full Text] [PDF]
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 T Kohnlein, T Welte, L B Tan, and M W Elliott Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature Thorax, June 1, 2002; 57(6): 547 - 554. [Abstract] [Full Text] [PDF]
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R. Schulz, G. Baseler, H.A. Ghofrani, F. Grimminger, H. Olschewski, and W. Seeger Nocturnal periodic breathing in primary pulmonary hypertension Eur. Respir. J., April 1, 2002; 19(4): 658 - 663. [Abstract] [Full Text] [PDF]
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G. Lorenzi-Filho, E.R. Azevedo, J.D. Parker, and T.D. Bradley Relationship of carbon dioxide tension in arterial blood to pulmonary wedge pressure in heart failure Eur. Respir. J., January 1, 2002; 19(1): 37 - 40. [Abstract] [Full Text] [PDF]
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 R. Shabetai Depression and Heart Failure Psychosom Med, January 1, 2002; 64(1): 13 - 14. [Full Text] [PDF]
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R. S. T. LEUNG and T. DOUGLAS BRADLEY Sleep Apnea and Cardiovascular Disease Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165. [Full Text] [PDF]
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A. T. Yan, T. D. Bradley, and P. P. Liu The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure Chest, November 1, 2001; 120(5): 1675 - 1685. [Abstract] [Full Text] [PDF]
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H. TESCHLER, J. DOHRING, Y.-M. WANG, and M. BERTHON-JONES Adaptive Pressure Support Servo-Ventilation . A Novel Treatment for Cheyne-Stokes Respiration in Heart Failure Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 614 - 619. [Abstract] [Full Text] [PDF]
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G.N. Willson, I. Wilcox, A.J. Piper, W.E. Flynn, M. Norman, R.R. Grunstein, and C.E. Sullivan Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokes respiration during sleep Eur. Respir. J., June 1, 2001; 17(6): 1250 - 1257. [Abstract] [Full Text] [PDF]
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S Heindl, C Dodt, M Krahwinkel, G Hasenfuss, and S Andreas Short term effect of continuous positive airway pressure on muscle sympathetic nerve activity in patients with chronic heart failure Heart, February 1, 2001; 85(2): 185 - 190. [Abstract] [Full Text]
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P. SOLIN, T. ROEBUCK, D. P. JOHNS, E. HAYDN WALTERS, and M. T. NAUGHTON Peripheral and Central Ventilatory Responses in Central Sleep Apnea with and without Congestive Heart Failure Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2194 - 2200. [Abstract] [Full Text]
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 L. L. Clark Perioperative Treatment of Congestive Heart Failure Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2000; 4(4): 223 - 235. [Abstract] [PDF]
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D. P. Francis, K. Willson, L. C. Davies, A. J.S. Coats, and M. Piepoli Quantitative General Theory for Periodic Breathing in Chronic Heart Failure and its Clinical Implications Circulation, October 31, 2000; 102(18): 2214 - 2221. [Abstract] [Full Text] [PDF]
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D. D. Sin, A. G. Logan, F. S. Fitzgerald, P. P. Liu, and T. D. Bradley Effects of Continuous Positive Airway Pressure on Cardiovascular Outcomes in Heart Failure Patients With and Without Cheyne-Stokes Respiration Circulation, July 4, 2000; 102(1): 61 - 66. [Abstract] [Full Text] [PDF]
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 T. D. Bradley Continuous positive airway pressure for congestive heart failure Can. Med. Assoc. J., February 1, 2000; 162(4): 535 - 536. [Full Text] [PDF]
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D. D. SIN, F. FITZGERALD, J. D. PARKER, G. NEWTON, J. S. FLORAS, and T. D. BRADLEY Risk Factors for Central and Obstructive Sleep Apnea in 450 Men And Women with Congestive Heart Failure Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1101 - 1106. [Abstract] [Full Text]
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 S. Andreas Nocturnal insights in chronic heart failure Eur. Heart J., August 2, 1999; 20(16): 1140 - 1141. [PDF]
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