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Nocturnal Dyspnea and Atrial Fibrillation Predict Cheyne-Stokes Respirations in Patients With Congestive Heart Failure

Nocturnal Dyspnea and Atrial Fibrillation Predict Cheyne-Stokes Respirations in Patients With... Abstract Background: Cheyne-Stokes respirations have frequently been noted in highly selected groups of patients with congestive heart failure, but their prevalence in an unselected population with congestive heart failure is undefined. Methods: One hundred consecutive unselected outpatients or stable inpatients with clinical congestive heart failure encountered by three clinical cardiologists during a 6-month period were screened for Cheyne-Stokes respirations with overnight oximetry. Results: The mean age (±SD) of the patients was 70±8.6 years. Of the 100 patients, 33% had had previous coronary bypass surgery, 77% were men, 57% had hypertension, and 32% had atrial fibrillation. The mean ejection fraction (±SD) was 34%±13%. Periodic breathing was assessed qualitatively as Cheyne-Stokes respirations in 27% of patients, nonspecific sleep-disordered breathing (apneas and/or hypopneas) in 43%, and normal in 30%. For patients with Cheyne-Stokes respirations, patients with nonspecific sleep-disordered breathing, and normal subjects, the mean numbers of oxyhemoglobin desaturation events per hour were 24, 10, and 2, and the total numbers of desaturations of 4% or more that lasted less than 3 minutes were 172, 74, and 13. Independent predictors of Cheyne-Stokes respirations vs non—Cheyne-Stokes respirations included a history of nocturnal dyspnea (odds ratio, 4.00; 95% confidence interval, 1.33 to 12.04; P=.01) and atrial fibrillation (odds ratio, 3.24; 95% confidence interval, 1.21 to 8.48; P=.02). Conclusions: Cheyne-Stokes respirations and nonspecific sleep-disordered breathing are common in unselected patients with congestive heart failure, and Cheyne-Stokes respirations are predicted by a history of nocturnal dyspnea and the presence of atrial fibrillation. Techniques designed to modify the nocturnal breathing pattern of patients with congestive heart failure may be applicable to a large portion of the congestive heart failure population.(Arch Intern Med. 1995;155:1297-1302) References 1. Harrison TR, King CE, Calhoun JA, Harrison WG. Congestive heart failure: Cheyne-Stokes respiration as the cause of paroxysmal dyspnea at the onset of sleep. Arch Intern Med . 1934;53:891-910.Crossref 2. Findley LJ, Zwillich CW, Ancoli-lsrael S, Kripke D, Tisi G, Moser KM. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure. South Med J . 1985;78:11-15.Crossref 3. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH. Respiration and abnormal sleep in patients with congestive heart failure. Chest . 1989;96: 480-488.Crossref 4. Hoffman R, Agatston A, Krieger B. Cheyne-Stokes respiration in patients recovering from acute cardiogenic pulmonary edema. Chest . 1990;97:410-412.Crossref 5. Cripps T, Rocker G, Stradling J. Nocturnal hypoxia and arrhythmias in patients with impaired left ventricular function. Br Heart J . 1992;68:382-386.Crossref 6. Andreas S, von Breska B, Kopp E, Figulla HR, Kreuzer H. Periodic respiration in patients with heart failure. Clin Invest . 1993;71:281-285.Crossref 7. Naughton M, Benard D, Tam A, Rutherford R, Bradley TD. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis . 1993;148:330-338.Crossref 8. Hanly PJ, Zuberi N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Am Rev Respir Dis . 1993;148:A688. Abstract. 9. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med . 1989;111:777-782.Crossref 10. Braghiroli A, DeVito F, Sacco C, et al. Six months oxygen therapy in patients with congestive heart failure: preliminary results. Am Rev Respir Dis . 1992; 145:A446. Abstract. 11. Dowdell WT, Javaheri S, McGinnis W. Cheyne-Stokes respirations presenting as sleep apnea syndrome. Am Rev Respir Dis . 1990;141:871-879.Crossref 12. Bradley TD, Holloway RM, McLaughlin PR, Ross BL, Walters J, Liu PP. Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis . 1992;145:377-382.Crossref 13. Naughton MT, Lui PP, Benard DC, Goldstein RS, Bradley TD. Chronic effect of continuous positive airway pressure on ejection fraction in patients with congestive heart failure and Cheyne-Stokes respirations. Circulation . 1993;88:I-25. Abstract. 14. Takasaki Y, Orr D, Popkin J, Rutherford R, Liu P, Bradley TD. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure. Am Rev Respir Dis . 1989;140:1578-1584.Crossref 15. Naughton MT, Benard DC, Liu PP, Rutherford R, Bradley TD. Sympathoadrenal activity in patients with congestive heart failure and Cheyne-Stokes respiration during sleep. Circulation . 1993;88:I-257. Abstract. 16. Series F, Marc I, Cormier Y, La Forge J. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med . 1993;119:449-453.Crossref 17. Warley ARH, Mitchell JH, Stradling JR. Evaluation of the Ohmeda 3700 pulse oximeter. Thorax . 1987;42:892-896.Crossref 18. Stradling J, Apps M, Calverley P, Chadwick G, McNicholas W. Adequacy of oximetry-alone studies for the diagnosis of sleep and breathing disorders. J Ambulatory Monit . 1989;3:197-201. 19. Leavitt RH, Shudde WJ, Stillwell PC. The documentation of oxygen saturation by computerized pulse oximetry in pediatric patients with chronic lung disease. Respir Care . 1989;34:349-354. 20. Renaux SR, Fredrickson PA, Kaplan J, Quinlan KA. Comparison of computer analyzed trend oximetry data and polysomnography. Sleep Res . 1991;20:437. Abstract. 21. Cooper BG, Veale D, Griffiths CJ, Gibson GJ. Value of nocturnal oxygen saturation as a screening test for sleep apnoea. Thorax . 1991;46:586-588.Crossref 22. Ho KKL, Pinsky, JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol . 1993;22( (suppl A) ):6A-13A.Crossref 23. Brandes WC, Kubiet MA, Mills RM, Limacher MC, Block AJ. Sleep and breathing in patients awaiting cardiac transplantation. Am Rev Respir Dis . 1993;147: A687. 24. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep disordered breathing in community-dwelling elderly. Sleep . 1991;14:486-495. 25. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure: a study of 390 patients. Circulation . 1991; 84:40-48.Crossref 26. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN, V-HeFT VA Cooperative Studies Group. The influence of atrial fibrillation on prognosis in mild to moderate heart failure: the V-HeFT studies. Circulation . 1993; 87( (suppl VI) ):VI-102—VI-110. 27. Kerr CR, Chung DC. Atrial fibrillation: fact, controversy and future. Clin Prog Electrophysiol Pacing . 1985;3:319-337.Crossref 28. Ben-Dov I, Sietsema KE, Casaburi R, Wasserman K. Evidence that circulatory oscillations accompany ventilatory oscillations during exercise in patients with heart failure. Am Rev Respir Dis . 1992;145:776-781.Crossref 29. Maze SS, Kotler MN, Parry WR. Doppler evaluation of changing cardiac dynamics during Cheyne-Stokes respiration. Chest . 1989;95:525-529.Crossref 30. Lloyd TC. Effect of increased left atrial pressure on breathing frequency in anesthetized dog. J Appl Physiol . 1990;69:1973-1980. 31. Otsuka K, Sadakane N, Ozawa T. Arrhythmogenic properties of disordered breathing during sleep in patients with cardiovascular disorders. Clin Cardiol . 1987; 10:771-782.Crossref 32. Davies SW, John LM, Wedzicha JA, Lipkin DP. Overnight studies in severe chronic left heart failure: arrhythmias and oxygen desaturation. Br Heart J . 1991;65:77-83.Crossref 33. Guilleminault C, Stoohs R, Labanowski M, Simmons J, Clerk A. Cardiac failure, snoring, ventricular arrhythmias and nasal bilevel positive pressure ventilation. Sleep . 1993;16:S139-S140. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Nocturnal Dyspnea and Atrial Fibrillation Predict Cheyne-Stokes Respirations in Patients With Congestive Heart Failure

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References (34)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430120081010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Cheyne-Stokes respirations have frequently been noted in highly selected groups of patients with congestive heart failure, but their prevalence in an unselected population with congestive heart failure is undefined. Methods: One hundred consecutive unselected outpatients or stable inpatients with clinical congestive heart failure encountered by three clinical cardiologists during a 6-month period were screened for Cheyne-Stokes respirations with overnight oximetry. Results: The mean age (±SD) of the patients was 70±8.6 years. Of the 100 patients, 33% had had previous coronary bypass surgery, 77% were men, 57% had hypertension, and 32% had atrial fibrillation. The mean ejection fraction (±SD) was 34%±13%. Periodic breathing was assessed qualitatively as Cheyne-Stokes respirations in 27% of patients, nonspecific sleep-disordered breathing (apneas and/or hypopneas) in 43%, and normal in 30%. For patients with Cheyne-Stokes respirations, patients with nonspecific sleep-disordered breathing, and normal subjects, the mean numbers of oxyhemoglobin desaturation events per hour were 24, 10, and 2, and the total numbers of desaturations of 4% or more that lasted less than 3 minutes were 172, 74, and 13. Independent predictors of Cheyne-Stokes respirations vs non—Cheyne-Stokes respirations included a history of nocturnal dyspnea (odds ratio, 4.00; 95% confidence interval, 1.33 to 12.04; P=.01) and atrial fibrillation (odds ratio, 3.24; 95% confidence interval, 1.21 to 8.48; P=.02). Conclusions: Cheyne-Stokes respirations and nonspecific sleep-disordered breathing are common in unselected patients with congestive heart failure, and Cheyne-Stokes respirations are predicted by a history of nocturnal dyspnea and the presence of atrial fibrillation. Techniques designed to modify the nocturnal breathing pattern of patients with congestive heart failure may be applicable to a large portion of the congestive heart failure population.(Arch Intern Med. 1995;155:1297-1302) References 1. Harrison TR, King CE, Calhoun JA, Harrison WG. Congestive heart failure: Cheyne-Stokes respiration as the cause of paroxysmal dyspnea at the onset of sleep. Arch Intern Med . 1934;53:891-910.Crossref 2. Findley LJ, Zwillich CW, Ancoli-lsrael S, Kripke D, Tisi G, Moser KM. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure. South Med J . 1985;78:11-15.Crossref 3. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH. Respiration and abnormal sleep in patients with congestive heart failure. Chest . 1989;96: 480-488.Crossref 4. Hoffman R, Agatston A, Krieger B. Cheyne-Stokes respiration in patients recovering from acute cardiogenic pulmonary edema. Chest . 1990;97:410-412.Crossref 5. Cripps T, Rocker G, Stradling J. Nocturnal hypoxia and arrhythmias in patients with impaired left ventricular function. Br Heart J . 1992;68:382-386.Crossref 6. Andreas S, von Breska B, Kopp E, Figulla HR, Kreuzer H. Periodic respiration in patients with heart failure. Clin Invest . 1993;71:281-285.Crossref 7. Naughton M, Benard D, Tam A, Rutherford R, Bradley TD. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis . 1993;148:330-338.Crossref 8. Hanly PJ, Zuberi N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Am Rev Respir Dis . 1993;148:A688. Abstract. 9. Hanly PJ, Millar TW, Steljes DG, Baert R, Frais MA, Kryger MH. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med . 1989;111:777-782.Crossref 10. Braghiroli A, DeVito F, Sacco C, et al. Six months oxygen therapy in patients with congestive heart failure: preliminary results. Am Rev Respir Dis . 1992; 145:A446. Abstract. 11. Dowdell WT, Javaheri S, McGinnis W. Cheyne-Stokes respirations presenting as sleep apnea syndrome. Am Rev Respir Dis . 1990;141:871-879.Crossref 12. Bradley TD, Holloway RM, McLaughlin PR, Ross BL, Walters J, Liu PP. Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis . 1992;145:377-382.Crossref 13. Naughton MT, Lui PP, Benard DC, Goldstein RS, Bradley TD. Chronic effect of continuous positive airway pressure on ejection fraction in patients with congestive heart failure and Cheyne-Stokes respirations. Circulation . 1993;88:I-25. Abstract. 14. Takasaki Y, Orr D, Popkin J, Rutherford R, Liu P, Bradley TD. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure. Am Rev Respir Dis . 1989;140:1578-1584.Crossref 15. Naughton MT, Benard DC, Liu PP, Rutherford R, Bradley TD. Sympathoadrenal activity in patients with congestive heart failure and Cheyne-Stokes respiration during sleep. Circulation . 1993;88:I-257. Abstract. 16. Series F, Marc I, Cormier Y, La Forge J. Utility of nocturnal home oximetry for case finding in patients with suspected sleep apnea hypopnea syndrome. Ann Intern Med . 1993;119:449-453.Crossref 17. Warley ARH, Mitchell JH, Stradling JR. Evaluation of the Ohmeda 3700 pulse oximeter. Thorax . 1987;42:892-896.Crossref 18. Stradling J, Apps M, Calverley P, Chadwick G, McNicholas W. Adequacy of oximetry-alone studies for the diagnosis of sleep and breathing disorders. J Ambulatory Monit . 1989;3:197-201. 19. Leavitt RH, Shudde WJ, Stillwell PC. The documentation of oxygen saturation by computerized pulse oximetry in pediatric patients with chronic lung disease. Respir Care . 1989;34:349-354. 20. Renaux SR, Fredrickson PA, Kaplan J, Quinlan KA. Comparison of computer analyzed trend oximetry data and polysomnography. Sleep Res . 1991;20:437. Abstract. 21. Cooper BG, Veale D, Griffiths CJ, Gibson GJ. Value of nocturnal oxygen saturation as a screening test for sleep apnoea. Thorax . 1991;46:586-588.Crossref 22. Ho KKL, Pinsky, JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol . 1993;22( (suppl A) ):6A-13A.Crossref 23. Brandes WC, Kubiet MA, Mills RM, Limacher MC, Block AJ. Sleep and breathing in patients awaiting cardiac transplantation. Am Rev Respir Dis . 1993;147: A687. 24. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep disordered breathing in community-dwelling elderly. Sleep . 1991;14:486-495. 25. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure: a study of 390 patients. Circulation . 1991; 84:40-48.Crossref 26. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN, V-HeFT VA Cooperative Studies Group. The influence of atrial fibrillation on prognosis in mild to moderate heart failure: the V-HeFT studies. Circulation . 1993; 87( (suppl VI) ):VI-102—VI-110. 27. Kerr CR, Chung DC. Atrial fibrillation: fact, controversy and future. Clin Prog Electrophysiol Pacing . 1985;3:319-337.Crossref 28. Ben-Dov I, Sietsema KE, Casaburi R, Wasserman K. Evidence that circulatory oscillations accompany ventilatory oscillations during exercise in patients with heart failure. Am Rev Respir Dis . 1992;145:776-781.Crossref 29. Maze SS, Kotler MN, Parry WR. Doppler evaluation of changing cardiac dynamics during Cheyne-Stokes respiration. Chest . 1989;95:525-529.Crossref 30. Lloyd TC. Effect of increased left atrial pressure on breathing frequency in anesthetized dog. J Appl Physiol . 1990;69:1973-1980. 31. Otsuka K, Sadakane N, Ozawa T. Arrhythmogenic properties of disordered breathing during sleep in patients with cardiovascular disorders. Clin Cardiol . 1987; 10:771-782.Crossref 32. Davies SW, John LM, Wedzicha JA, Lipkin DP. Overnight studies in severe chronic left heart failure: arrhythmias and oxygen desaturation. Br Heart J . 1991;65:77-83.Crossref 33. Guilleminault C, Stoohs R, Labanowski M, Simmons J, Clerk A. Cardiac failure, snoring, ventricular arrhythmias and nasal bilevel positive pressure ventilation. Sleep . 1993;16:S139-S140.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 26, 1995

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