Chest
Clinical InvestigationsEffects of Cardiac Dysfunction on Non-Hypercapnic Central Sleep Apnea
Section snippets
Subjects
Subjects aged 18 to 75 years were selected on the basis of (1) at least two of following clinical features: snoring, witnessed apnea, excessive daytime sleepiness, restless sleep, or nocturnal dyspnea; (2) CSA during non-REM sleep (>10 apneas per hour); and (3) mean overnight transcutaneous Pco2 ≤45 mm Hg.
Consecutive subjects with and without a history of CHF were recruited. A history of CHF constituted ≥6 months of dyspnea, a documented hospital admission for CHF associated with radiologic
Characteristics of Subjects
Twenty male subjects were studied, 10 in each group. The non-CHF group was slightly younger (50.3±2.8 years vs 57.8±2.1 years; p=0.046) and had a greater mean body mass index (30.6±1.1 kg/m2 vs 25.6±0.8 kg/m2; p=0.002) than the CHF group (Table 1). Arterial blood gases awake were in the normal range and were comparable except for the pH which was statistically higher in the CHF group (7.41 ±0.01 vs 7.44±0.01; p<0.01). Spirometry was measured in all but one patient from each group and was
Discussion
The major finding in this study of subjects with non-hypercapnic CSA was that stable CHF could be predicted on polysomnography by means of either a VL:AL ratio >1.0, or prolonged circulation time >15 s with CL >45 s, but not by differences in AL. Moreover, LVEF correlated negatively with circulation time and CL.
In clinical practice, CHF is a major health problem in terms of mortality and morbidity.12 One cardinal feature of CHF is nocturnal dyspnea, which may precipitate referral to a sleep
Acknowledgments
We express our gratitude to Dr. Michael Kelly for the measurement and analysis of left ventricular ejection fractions, to Dr. Malcolm Wilkinson for discussions regarding theoretical measures of respiratory loop gain, to the Department of Cardiology, and to the staff of the Sleep Disorders Centre at the Alfred Hospital for technical support.
References (25)
- et al.
Experimentally induced Cheyne-Stokes breathing
Respir Physiol
(1979) - et al.
The entrainment of low frequency breathing periodicity
Chest
(1990) - et al.
Altitude acclimatization: influence on periodic breathing and chemoresponsiveness during sleep
J Appl Physiol
(1987) - et al.
Role of hyperventilation in the pathogenesis of central sleep apneas in subjects with congestive heart failure
Am Rev Respir Dis
(1993) - et al.
Central sleep apnea
Clin Chest Med
(1992) - et al.
Sleep induced periodic breathing and apnea: a theoretical study
J Appl Physiol
(1991) - et al.
Possible mechanisms of periodic breathing during sleep
J Appl Physiol
(1988) - et al.
The role of central chemosensitivity in central apnea of heart failure
Sleep
(1993) - et al.
Hypocapnia and increased ventilatory responsiveness in subjects with idiopathic central sleep apnea
Am J Respir Crit Care Med
(1995) - et al.
Pulmonary function abnormalities in chronic severe cardiomyopathy preceding cardiac transplantation
Am Rev Respir Dis
(1992)
Value of combined assessment of global and segmental ventricular contraction with right anterior oblique ECG-gated first-pass and left anterior oblique equilibrium radionuclide ventriculography
Eur J Nucl Med
A manual for standardized terminology, techniques and scoring system for sleep stages of human subjects: publication No. 204
Cited by (49)
Pathophysiology of Central Sleep Apnea and Complex Sleep Apnea Syndromes
2021, Encyclopedia of Respiratory Medicine, Second EditionOxygen therapy for management of periodic breathing: A theoretical approach
2017, Mathematical BiosciencesPhrenic nerve stimulation for central sleep apnea. Wiping out apnea or whipping the muscles?
2015, JACC: Heart FailureCheyne-stokes respiration
2014, Sleep Medicine ClinicsCitation Excerpt :It is often precipitated by a large arousal, movement, or state change. The apnea-hyperpnea cycle length, 45 to 75 seconds, can assist in distinguishing CSA of HF cause from other causes (such as narcotic or CPAP induced).17,51 CSA-CSR is usually worse in the supine position and can be alleviated by elevation of the head of the bed, or moving from supine to lateral body positions.
Supported by Astra Australian Lung Foundation Career Development Award and Viertal Foundation.