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Cheyne-stokes respiration during wakefulness in patients with chronic heart failure

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Cheyne-Stokes respiration (CSR) during sleep has been studied extensively in patients with chronic heart failure (CHF). Prevalence and prognostic significance of CSR during wakefulness in CHF, however, are largely unknown.

Methods

CSR during wakefulness with an apnea-hypopnea cut-off ≥5/h and moderate to severe CSR with an apnea-hypopnea cutoff ≥15/h were analyzed using polysomnographic recordings in 267 patients with stable CHF with reduced left ventricular (LV) ejection fraction at our institution. Primary endpoint during follow-up was heart transplant-free survival.

Results

Fifty of 267 patients (19%) had CSR during wakefulness and 73 of 267 patients (27%) had CSR during sleep. CSR during wakefulness was associated with advanced age, atrial fibrillation, decreased LV ejection fraction, increased LV end-diastolic diameter, brain natriuretic peptide, New York Heart Failure class, and CSR during sleep. During 43 months mean follow-up, 67 patients (25%) died and 4 patients (1%) underwent heart transplantation. Multivariate Cox analysis identified age, male gender, chronic kidney disease, and LV ejection fraction as predictors of reduced transplant-free survival. CSR during wakefulness with an apnea-hypopnea cutoff ≥5/h as well as moderate to severe CSR while awake using an apnea-hypopnea cutoff ≥15/h did not predict reduced transplant-free survival independently from confounding factors.

Conclusion

CSR during wakefulness appears to be a marker of heart failure severity.

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Acknowledgements

We thank Astrid Schäfer, Nicole Stawenow, Christian Voß, Henrik Achenbach and Sandra Apelt from the sleep disorder center of the Department of Pneumology of the University Hospital of Marburg for their help to conduct this study.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital of Marburg and Gießen, Marburg, Germany

    Wolfram Grimm

  2. Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany

    Karl Kesper, Werner Cassel, Olaf Hildebrandt & Ulrich Koehler

  3. Institute for Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany

    Nina Timmesfeld

Authors
  1. Wolfram Grimm
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  2. Karl Kesper
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  3. Werner Cassel
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  4. Nina Timmesfeld
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  5. Olaf Hildebrandt
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  6. Ulrich Koehler
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Corresponding author

Correspondence to Wolfram Grimm.

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Funding

Resmed GmbH & Co.KG, Martinsried, Germany, provided financial support in the form of a research grant. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Grimm, W., Kesper, K., Cassel, W. et al. Cheyne-stokes respiration during wakefulness in patients with chronic heart failure. Sleep Breath 21, 419–426 (2017). https://doi.org/10.1007/s11325-016-1433-x

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  • DOI: https://doi.org/10.1007/s11325-016-1433-x

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