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J Clin Sleep Med. 2017 Nov 15;13(11):1235-1241. doi: 10.5664/jcsm.6788.

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure.

Author information

1
University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.
2
Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, Ontario, Canada.
3
Universitätsklinikum Regensburg, Regensburg, Germany.
4
Hospital Universitario Txagorritxu, Vitoria, Spain.
5
Queen's University, Kingston, Ontario, Canada.
6
Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
7
Juntendo University Hospital, Tokyo, Japan.
8
McGill University Health Centre, Montreal, Quebec, Canada.
9
St Michael's Hospital, Toronto, Ontario, Canada.
10
Instituto do Coração do Hospital das Clínicas da FMUSP, Sao Paulo, Brazil.
11
Hôpital Hôtel-Dieu du CHUM, Université de Montréal, Montreal, Quebec, Canada.
12
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
13
Capital District Health Authority, Halifax, Nova Scotia, Canada.
14
Ospedale San Luca, Milan, Italy.
15
University of Arizona College of Medicine, Tucson, Arizona.
16
Groupe Hospitalier Pitie-Salpetriere Charles Fox, Paris, France.
17
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.

Erratum in

Abstract

STUDY OBJECTIVES:

In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF.

METHODS:

Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed.

RESULTS:

Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, P < .01), longer cycle time (67.8 ± 15.9 versus 51.7 ± 9.9 seconds, P < .01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P = .01), and worse New York Heart Association class (P = .02) than those with a positive pattern. LFCT and LVEF did not differ between groups.

CONCLUSIONS:

Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function.

COMMENTARY:

A commentary on this article appears in this issue on page 1227.

CLINICAL TRIAL REGISTRATION:

The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www.clinicaltrials.gov; NCT01128816).

KEYWORDS:

Cheyne-Stokes respiration; central sleep apnea; heart failure; hyperpnea

PMID:
29065956
PMCID:
PMC5656472
[Available on 2018-05-15]
DOI:
10.5664/jcsm.6788
[Indexed for MEDLINE]
Free PMC Article

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