This Article Full Text Full Text (PDF) All Versions of this Article: 107/15/1998    most recent 01.CIR.0000065227.04025.C2v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arzt, M. Articles by Pfeifer, M. Search for Related Content PubMed PubMed Citation Articles by Arzt, M. Articles by Pfeifer, M. Pubmed/NCBI databases Medline Plus Health Information Heart Failure Related Collections Exercise testing

(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

This article has been cited by other articles:

				I. Szollosi, B. R. Thompson, H. Krum, D. M. Kaye, and M. T. Naughton Impaired Pulmonary Diffusing Capacity and Hypoxia in Heart Failure Correlates With Central Sleep Apnea Severity Chest, July 1, 2008; 134(1): 67 - 72. [Abstract] [Full Text] [PDF]

				L. J. Olson and V. K. Somers Treating Central Sleep Apnea in Heart Failure: Outcomes Revisited Circulation, June 26, 2007; 115(25): 3140 - 3142. [Full Text] [PDF]

				M. Arzt and T. D. Bradley Treatment of Sleep Apnea in Heart Failure Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1300 - 1308. [Abstract] [Full Text] [PDF]

				M. Arzt, M. Schulz, R. Wensel, S. Montalvan, F. C. Blumberg, G. A. J. Riegger, and M. Pfeifer Nocturnal Continuous Positive Airway Pressure Improves Ventilatory Efficiency During Exercise in Patients With Chronic Heart Failure Chest, March 1, 2005; 127(3): 794 - 802. [Abstract] [Full Text] [PDF]

				J-L. Pepin, P. Defaye, S. Garrigue, Y. Poezevara, and P. Levy Overdrive atrial pacing does not improve obstructive sleep apnoea syndrome Eur. Respir. J., February 1, 2005; 25(2): 343 - 347. [Abstract] [Full Text] [PDF]

				A.-M. Sinha, E. C. Skobel, O.-A. Breithardt, C. Norra, K. U. Markus, C. Breuer, P. Hanrath, and C. Stellbrink Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure J. Am. Coll. Cardiol., July 7, 2004; 44(1): 68 - 71. [Abstract] [Full Text] [PDF]

				J. D Lowman Jr, A. Y. Jones, E. Dean, and C. C. Chow Breathing Exercises for Patients With COPD: To Teach or Not to Teach Physical Therapy, October 1, 2003; 83(10): 948 - 951. [Full Text]