Clinical Implications of Cheyne-Stokes Respiration During Wakefulness in Patients With Chronic Heart Failure: Experience in Japan

SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Cheyne-Stokes respiration (CSR), a disorder characterized by recurrent central apneas alternating with a crescendo-decrescendo pattern of tidal volume, during sleep is common in chronic heart failure (CHF). Episodic apnea with concomitant hypoxemia and arousal due to this condition may lead to increased sympathetic activity and ventricular arrthymias. The aim of the present study was to investigate clinical implications of CSR during the daytime by clinically comparing patients with CSR during both sleep and wakefulness and those with CSR only during sleep. METHODS: Of 70 consecutive patients with CHF undergoing polysomnography (PSG) for the last 5 years, 39 patients were diagnosed of CSR with central sleep apnea (CSA) during sleep. In this study, CSA-CSR was defined as follows: (1) at least 3 consecutive cycles of a cyclic crescendo-decrescendo change in the breathing amplitude and (2) CSA index (AHI) ≥15 events/h. Those were divided into 2 groups. One group was patients with CSR during both sleep and wakefulness (Gr. 1: 10 cases, 78.1 ± 7.0 y.o.). The other was those with CSR only during sleep (Gr. 2: 29 cases, 76.0 ± 8.1 y.o.). To make the diagnosis of CSR during wakefulness, patients underwent PSG for 30 minutes even after awaking. Gr. 1 and Gr. 2 were compared with regard to PSG data (AHI, oxygen desaturation index: ODI), arterial blood gas analysis (PaO2, PaCO2), cardiac ultrasound data (UCG data) and NTproBNP plasma levels. RESULTS: CSR during both sleep and wakefulness (Gr. 1) was found in 10 cases (26 %) and was associated with more severe central sleep apnea (AHI:43.3 ± 7.6 versus 30.5 ± 11.6 events/hr, p<0.05, ODI 5: 39.5 ± 10.7 versus 16.3 ± 12.6 events/hr, p<0.05 and total sleep time with SpO2 < 90%:12.8 ± 12.7 versus 3.9 ± 5.6%, p<0.05), higher level of hyperventilation in the daytime (PaCO2:32.8 ± 4.9 versus 36.3 ± 4.4 mmHg, p<0.05) and higher NTproBNP plasma levels (3201 ± 1841 versus 1904 ± 1754 pg/ml, p<0.05). There were, however, no differences in PaO2 and UCG data between these two groups. CONCLUSIONS: Cheyne-Stokes Respiration is surprisingly common in awake patients with chronic heart failure. This breathing disorder might be a marker of more severe central sleep apnea, more severe advanced chronic heart failure and poorer prognosis. CLINICAL IMPLICATIONS: In patients with CHF that is refractory to medical therapy, PSG while awake might be warranted. DISCLOSURE: The following authors have nothing to disclose: Minoru Kato, Yoshiko Isobe, Sadao Aoki, Hirofumi Sakurai, Shuji Oh-ishi, Takefumi Saito No Product/Research Disclosure Information