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Predictors of oxidative stress in heart failure patients with Cheyne–Stokes respiration

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Abstract

Purpose

Cheyne–Stokes respiration during sleep is associated with increased mortality in heart failure. The magnitude of oxidative stress is a marker of disease severity and a valuable predictor of mortality in heart failure. Increased oxidative stress associated with periodic breathing during Cheyne–Stokes respiration may mediate increased mortality in these patients. We hypothesized that the presence of Cheyne–Stokes respiration is associated with oxidative stress by increasing the formation of reactive oxygen species in patients with heart failure.

Methods and results

Twenty-three patients with heart failure [left ventricular ejection fraction 30.2 ± 9% (mean ± standard deviation)] and 11 healthy controls underwent nocturnal polysomnography. Subjects with obstructive sleep apnea were excluded. The majority (88%) of patients with heart failure had Cheyne–Stokes respiration during sleep. The intensity of oxidative stress in neutrophils was greater in patients with heart failure (4,218 ± 1,706 mean fluorescence intensity/cell vs. 1,003 ± 348 for controls, p < 0.001) and correlated with the duration of Cheyne–Stokes respiration. Oxidative stress was negatively correlated with SaO2 nadir during sleep (r = −0.43, p = 0.039). The duration of Cheyne–Stokes respiration predicted severity of oxidative stress in patients with heart failure (beta = 483 mean fluorescence intensity/cell, p < 0.02).

Conclusions

Levels of oxidative stress are increased in patients with heart failure and Cheyne–Stokes respiration during sleep compared with healthy controls. The duration of Cheyne–Stokes respiration predicts the magnitude of oxidative stress in heart failure. Increased oxidative stress may mediate increased mortality associated with Cheyne–Stokes respiration in patients with heart failure.

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Acknowledgements

We would like to thank Ming Chen and Vanessa Coradin at the NYU Sleep Disorder Center for assistance in the performance and scoring of the sleep studies, Daniel Meyer and Michael Gregory at the Flow Cytometry Core for their contribution in performing the flow cytometry analyses, and Dr. Robert Kaner for his valuable comments in reviewing the manuscript.

Grant support

American Heart Association National Center, Scientist Development Award and National Institutes of Health.

Conflict of interest

None of the authors has a conflict of interest to disclose.

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Authors and Affiliations

  1. Weill Cornell Medical College of Cornell University, 425 East 61th Street – 5th floor, New York, NY 10065, USA

    Ana C. Krieger

  2. North Shore University Hospital, Manhasset, NY, USA

    Daniel Green

  3. VA New York Harbor Health Care System, New York, NY, USA

    Muriel T. Cruz & Steven P. Sedlis

  4. New York University School of Medicine, New York, NY, USA

    Frank Modersitzki, Doris S. Tse & Steven P. Sedlis

  5. University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA

    Gita Yitta

  6. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Sanja Jelic

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  1. Ana C. Krieger
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Correspondence to Ana C. Krieger.

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Krieger, A.C., Green, D., Cruz, M.T. et al. Predictors of oxidative stress in heart failure patients with Cheyne–Stokes respiration. Sleep Breath 15, 827–835 (2011). https://doi.org/10.1007/s11325-010-0444-2

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