Improvements of central respiratory events, Cheyne-Stokes respiration and oxygenation in patients hospitalized for acute decompensated heart failure

Background: Sleep-disordered breathing (SDB), and Cheyne-Stokes respiration (CSR) in particular, are associated with reduced survival in patients with acute decompensated heart failure (ADHF). CSR cycle length (CL) has been shown to mirror heart failure severity and therefore may be a predictor of outcome. However, studies characterizing CSR in ADHF are rare and no study has investigated changes in CSR from admission to discharge in ADHF patients.

Methods: Consecutive patients admitted to our Academic Medical Center with ADHF were eligible. Study patients underwent two multichannel cardiorespiratory polygraphy (PG) recordings, one on admission and another during recompensation.

Results: 105 patients (age 71.5 ± 12.1 years, 66.7% male, NYHA class 3.2 ± 0.6, left ventricular ejection fraction 38.5 ± 13.3%, brain natriuretic peptide 1299 ± 1290 pg/ml); 77 had two fully analyzable PG recordings. CSA prevalence on the first PG was 77%. Based on the apnea-hypopnea index (AHI), CSA was mild, moderate or severe in 21%, 39% and 40% of patients, respectively. During ADHF treatment, AHI decreased non-significantly from 54 ± 17/h to 48 ± 9/h (p = 0.06), central hypopnea index from 20.9 ± 14/h to 17.1 ± 6.2/h (p < 0.01), and time spent in CSR from 65.5 ± 28.4 to 63.7 ± 17.8 min (p < 0.01); oxygenation improved from 91.4 ± 2.6% to 92.0 ± 1.5% (p < 0.05). There was no significant change in CL.

Conclusions: Patients with ADHF have a high prevalence of central respiratory events, which decreased during cardiac recompensation. Cardiac recompensation also non-significantly improved the AHI and time spent in CSR and oxygenation, but had no clear impact on CSR CL, which leaves clinical account open to further investigation.