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Daytime Cheyne-Stokes Respiration In Ambulatory Patients With Severe Congestive Heart Failure Is Associated With Increased Mortality

Thomas Brack, M.D., FCCP^*; Irene Thüer, M.D.^*; Christian F. Clarenbach, M.D.^*; Oliver Senn, M.D.^*; Georg Noll, M.D.; Erich W. Russi, M.D., FCCP^* and Konrad E. Bloch, M.D., FCCP^*,¶

^*Pulmonary and Cardiology Divisions, University Hospital, 8091 Zurich, and ^¶Center for Integrative Human Physiology, University of Zurich, Switzerland

pneubloc{at}usz.unizh.ch

Abstract

BackgroundCheyne-Stokes respiration (CSR) frequently occurs in patients with severe heart failure during sleep and may increase mortality. Daytime CSR supposedly poses an even greater risk, but its prevalence and prognostic importance remained elusive by now. Therefore, we investigated the circadian prevalence of CSR and its influence on survival in patients with heart failure.

MethodsIn 60 consecutive ambulatory patients (mean age ±SE, 58.0±1.5 yrs; 6 women) with stable severe heart failure (left ventricular ejection fraction 26± 1%, NYHA class 2.6± 0.1) the breathing pattern was unobtrusively monitored during 24 h of usual activities with a portable respiratory inductive plethysmograph.

ResultsDuring nights, 62% of patients had 15 periodic breathing cycles per hour, during daytime the corresponding prevalence was 16%. CSR prevailed in 32±3% of the nighttime and in 10±2% of the daytime with peaks at 4 am, 2 pm and 6 pm. Eighteen patients with CSR during 10% of the daytime lived shorter without heart transplantation than 42 patients with <10% of daytime CSR (p<0.05) during 836± 27 days of follow-up. CSR during 10% of the daytime was an independent predictor of mortality (hazard ratio 3.8; 95% confidence interval 1.1; 12.7, p<0.05) when controlling for age, sex, brain-natriuretic peptide, left ventricular ejection fraction and NYHA class.

ConclusionsCheyne-Stokes respiration occurs in 62% of patients with severe heart failure at night and in 16% during daytime. Since daytime CSR is associated with reduced survival, solely performing sleep studies may not allow to adequately assess prognosis and tailor treatment in severe heart failure.

Key Words: Cheyne-Stokes respiration • heart failure • mortality • prognosis

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Testing for Cheyne-Stokes Respiration in Patients With Heart Failure: While Sleeping or Cycling?

Matthew T. Naughton
Chest 2007 132: 1416-1418. [Full Text] [PDF]

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				S. Ulrich, M. Fischler, R. Speich, and K. E. Bloch Sleep-Related Breathing Disorders in Patients With Pulmonary Hypertension Chest, June 1, 2008; 133(6): 1375 - 1380. [Abstract] [Full Text] [PDF]

				M. T. Naughton Testing for Cheyne-Stokes Respiration in Patients With Heart Failure: While Sleeping or Cycling? Chest, November 1, 2007; 132(5): 1416 - 1418. [Full Text] [PDF]