Clinical characteristics of hospitalized heart failure patients with daytime cheyne-stokes respiration

Abstract

Introduction Cheyne-Stokes respiration (CSR) frequently occurs in patients with heart failure (HF). CSR in HF patients is important because it may independently predict morbidity and mortality due to HF. In previous analyses of HF patients, CSR was observed not only in the nighttime but also in the daytime. Moreover, daytime CSR may also predict worse prognosis in HF patients. Most of these studies have evaluated HF patients only on chronic phase. Daytime CSR in patients with HF on sub-acute phase (during hospitalization) remains unknown. We therefore investigated prevalence and clinical characteristics of daytime CSR in hospitalized patients with worsening of HF. Materials and methods In consecutive patients who were hospitalized due to worsening of HF, breathing pattern was monitored with a portable respiratory polygraph continuously over 24 h after their condition was stabilized. The monitor comprised sensors for airflow and for respiratory effort and a pulse oximeter finger sensor. Body weight and blood test data were collected simultaneously. Results 28 HF patients were enrolled (age, 71.1_ plus/minus 11.4 years; 9 women; LVEF, 51.8_ plus/minus 15.1 %). Daytime CSR was highly prevalent (N = 22, 78.6%). In the nighttime, frequency of apneas and hypopneas per hour of recording expressed as nighttime apnea- hypopnea index (nAHI) was 19.0_ plus/minus 10.5 whereas AHI in the daytime (dAHI) was 8.8_ plus/minus 5.7. The patients were divided into two groups according to median value of the dAHI: higher dAHI group (dAHI ⩾ 8.4) and lower dAHI group (dAHI 8.4). We found no significant differences between two groups in baseline characteristics including age, sex, body mass index, plasma brain natriuretic peptide level, LVEF, New York Heart Association class, PaCO2 and the presence of atrial fibrillation or ischemic heart disease (IHD). We only found significant difference in lung-to-finger circulation time (LFCT) between two groups (38.0 vs 24.0 s; p 0.001) despite no difference in other cardiac parameters.In addition, LFCT was correlated with dAHI (r = 0.71, p 0.0001). LFCT was longer in men (men vs women, 33.8 vs 24.9 s, p 0.05) and patients with IHD (36.5 vs 26.5 s, p 0.01). Conclusion Daytime CSR is frequent in hospitalized patients with HF and is correlated with prolonged LFCT. Prolonged LFCT, which indicates impaired cardiac output, has an adverse effect on survival. Therefore, significant daytime CSR in hospitalized patients with HF might be a predictor of increased morbidity and mortality. Acknowledgements We express gratitude to all those who participated in this study.