Published Online
on April 14, 2003

A more recent version of this article appeared on April 22, 2003

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Submitted on December 16, 2002
Accepted on February 7, 2003

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, and Michael Pfeifer MD

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

^* To whom correspondence should be addressed. 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 (VE/VCO₂ 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 VO₂, 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 VO₂, percent of predicted value; P=0.260) and LVEF (percent, P=0.886). In contrast, the positive correlation of the VE/VCO₂ slope, determined by cardiopulmonary exercise testing, with the AHI was highly significant (P<0.001). The VE/VCO₂ 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 VO₂ and LVEF, the VE/VCO₂ 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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