Abstract
Background
Although sleep apnea has recently become a concern in patients with congestive heart failure (CHF), some patients with CHF exhibit characteristic oscillatory ventilation (OV) even when they are awake. We investigated the clinical significance of OV in patients with CHF, and effects of open‐heart surgery on the OV.
Hypothesis
OV is an indicator of the severity of CHF, and this abnormal respiratory pattern improves with hemodynamic changes after open‐heart surgery.
Methods
According to respiratory pattern in the cardiopulmonary exercise testing (CPX) before cardiac surgery, 50 patients with CHF were divided into 14 patients of OV‐positive (OV+) and 36 patients of OV‐negative (OV−). Then, the several indices of CPX before surgey, 1 week and 6 months after surgery were compared between the 2 groups.
Results
The peak VO2 before surgery was lower in OV+ patients than those in OV− patients (15.3 vs 18.8 m1/min/kg, p < 0.05). One week after surgery, anaerobic threshold (AT) and end‐tidal C02 (ETC02) were lower in OV+ patients than those in OV− patients (AT: 9.5 vs 10,7 ml/min/kg, p < 0.05, ETCO2: 5.3 vs 5.6%, p < 0.05). However, 6 months after surgery, the statistical differences of these CPX parameters between the 2 groups were not found, and OV disappeared in 79% of OV+ patients.
Conclusions
These data suggest that OV is an indicator of the severity of CHF, and gradually improved with the open‐heart surgery. Copyright © 2010 Wiley Periodicals, Inc.
Full Text
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References
- 1. Hanly PJ, Zuberi‐Khokhar NS. Increased mortality associated with Cheyne‐Stokes respiration in patients with congestive heart failure. Am J Respir Crit Care Med 1996; 153: 272–276. [DOI] [PubMed] [Google Scholar]
- 2. Lanfranchi PA, Braghiroli A, Bosimini E, et al. Prognostic value of nocturnal Cheyne‐Stokes respiration in chronic heart failure. Circulation 1999; 99: 1435–1440. [DOI] [PubMed] [Google Scholar]
- 3. Bradley TD, Floras JS. Sleep apnea and heart failure. Part II. Central sleep apnea. Circulation 2003; 107: 1822–1826. [DOI] [PubMed] [Google Scholar]
- 4. 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. [DOI] [PubMed] [Google Scholar]
- 5. Kremser CB, O'Toole MF, Leff AR. Oscillatory hyperventilation in severe congestive heart failure to idiopathic dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol 1987; 59: 900–905. [DOI] [PubMed] [Google Scholar]
- 6. Yajima T, Koike A, Sugimoto K, Miyahara Y, Marumo F, Hiroe M. Mechanism of periodic breathing in patients with cardiovascular disease. Chest 1994; 106: 142–146. [DOI] [PubMed] [Google Scholar]
- 7. Koike A, Shimizu N, Tajima A, et al. Relation between oscillatory ventilation at rest before cardiopulmonary exercise testing and prognosis in patients with left ventricular dysfunction. Chest 2003; 123: 372–379. [DOI] [PubMed] [Google Scholar]
- 8. Yamazaki T, Ueshima K, Kobayashi N, et al. The results of cardiopulmonary exercise testing in patients with heart failure and awake oscillatory ventilation [in Japanese]. Shinzo 1999; 31(suppl 2): 65–67. [Google Scholar]
- 9. Javaheri S. Heart failure and sleep disordered breathing. Central sleep apnea‐hypopnea syndrome in heart failure: prevalence, impact, and treatment. Sleep 1996; 19: S229–231. [PubMed] [Google Scholar]
- 10. Pryor WW. Cheyne‐Stokes respiration in patients with cardiac enlargement and prolonged circulation time. Circulation 1951; 4: 223–228. [DOI] [PubMed] [Google Scholar]
- 11. van de Borne P, Oren R, Abouassaly C, Anderson E, Somers VK. Effect of Cheyne‐Stokes respiration on muscle sympathetic nerve activity in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1998; 81: 432–436. [DOI] [PubMed] [Google Scholar]
- 12. Meguro K, Adachi H, Oshima S, Taniguchi K, Nagai R. Exercise tolerance, exercise hyperpnea and central chemosensitivity to carbon dioxide in sleep apnea syndrome in heart failure patient. Circ J 2005; 69: 695–699. [DOI] [PubMed] [Google Scholar]