Published online before print December 27, 2005, doi: 10.1161/CIRCULATIONAHA.105.543173
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(Circulation. 2006;113:44-50.)
© 2006 American Heart Association, Inc.
Heart Failure |
Sleep and Exertional Periodic Breathing in Chronic Heart Failure
Prognostic Importance and Interdependence
From the Division of Cardiology (U.C., M.P., A.M., M.G., P.G.), Division of Pulmonary Disease (A.B.), and Bioengineering Department (A.G.), Salvatore Maugeri Foundation, IRCCS, Veruno, Italy; Research Center (P.L.), Hôpital du Sacré-C
ur de Montréal, Montréal, Canada; and Division of Cardiology, Clinica Major (E.B.), Salvatore Maugeri Foundation, IRCCS, Torino, Italy.
Correspondence to Dr Ugo Corrà, Divisione di Cardiologia, Fondazione Salvatore Maugeri, Via per Revislate 13, 28010 Veruno, Italy. E-mail ucorra{at}fsm.it
Received February 15, 2005; revision received September 1, 2005; accepted September 12, 2005.
Background— Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown.
Methods and Results— We studied 133 CHF patients with left ventricular ejection fraction (LVEF) 
40%. During 1170±631 days of follow-up, 31 patients (23%) died. Nonsurvivors had higher New York Heart Association class, ventilatory response (
E/CO2 slope), and apnea-hypopnea index (AHI) and lower peak O2 (all P<0.01); lower LVEF and prescription of ß-blockers, and shorter transmitral deceleration time (all P<0.05). Exertional oscillatory ventilation (EOV), established by cyclic fluctuations in minute ventilation that persisted for 
60% of exercise duration with an amplitude 15% of the average resting value, was significantly more frequent in nonsurvivors (42% versus 15%, P<0.01). Multivariable analysis selected AHI (hazard ratio [HR] 5.66, 95% CI 2.3 to 19.9, P<0.01), peak O2 (HR 0.93, 95% CI 0.90 to 0.97, P<0.01), and ß-blocker prescription (HR 0.34, 95% CI 0.13 to 0.87, P<0.05) as predictors of cardiac events. The best cutoff for AHI was >30/h. EOV was significantly related to AHI >30/h (
2 14.6, P<0.01): 78% of EOV patients showed AHI >30/h. Multivariable analysis, including breathing disorders alone (EOV, AHI >30/h) or in combination (EOV plus AHI >30/h), selected combined disorders as the strongest predictor of events (HR 6.65, 95% CI 2.6 to 17.1, P<0.01).
Conclusions— In CHF, EOV is significantly associated with AHI >30/h. Although each breathing disorder alone is linked to total mortality, their combination has a crucial prognostic burden.
Key Words: heart failure • sleep • prognosis • exercise • ventilation
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