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(Circulation. 2003;107:1998.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Central Sleep Apnea

Michael Arzt, MD; Martina Harth, MD; Andreas Luchner, MD; Frank Muders, MD; Stephan R. Holmer, MD; Friedrich C. Blumberg, MD; Günter A.J. Riegger, MD; Michael Pfeifer, MD

From the Klinik und Poliklinik für Innere Medizin II, Universität Regensburg, Germany.

Correspondence to Dr Michael Arzt, Department of Internal Medicine II, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93042 Regensburg, Germany. E-mail michael.arzt{at}klinik.uni-regensburg.de

Background— In patients with chronic heart failure (CHF), central sleep apnea (CSA) and enhanced ventilatory response (E/CO₂ slope) to exercise are common. Both breathing disorders alone indicate poor prognosis in CHF. Although augmented chemosensitivity to CO₂ is thought to be one important underlying mechanism for both breathing disorders, it is unclear whether both breathing disorders are related closely in patients with CHF.

Methods and Results— We investigated 20 CHF patients with clinically important CSA (apnea-hypopnea-index (AHI), number of episodes per hour 15) and 10 CHF patients without CSA. Patients with and without CSA did not differ with respect to exercise capacity (peak O₂, 63.4±3.4% versus 60.8±4.4% of predicted value; P=0.746) and left ventricular ejection fraction (LVEF, 31±2% versus 31±3%; P=0.948). The AHI was not correlated with exercise capacity (peak O₂, percent of predicted value; P=0.260) and LVEF (percent, P=0.886). In contrast, the positive correlation of the E/CO₂ slope, determined by cardiopulmonary exercise testing, with the AHI was highly significant (P<0.001). The E/CO₂ slope was significantly increased in patients with CSA compared with those without CSA (29.7 versus 24.9; P<0.001).

Conclusions— The ventilatory response to exercise is significantly augmented in CHF patients with CSA compared with those without. In contrast to peak O₂ and LVEF, the E/CO₂ slope is strongly related to the severity of CSA in patients with CHF, which underscores an augmented chemosensitivity to CO₂ as a common underlying pathophysiological mechanism.

Key Words: heart failure • sleep • exercise • ventilation

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