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(Circulation. 2006;113:9-10.)
© 2006 American Heart Association, Inc.

Editorial

Periodic Breathing in Heart Failure

Bridging the Gap Between the Sleep Laboratory and the Exercise Laboratory

Jorge P. Ribeiro, MD, ScD

From the Cardiology Division, Hospital de Clínicas de Porto Alegre and Department of Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Correspondence to Jorge P. Ribeiro, MD, ScD, Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 90035–007, Porto Alegre, RS Brazil. E-mail jpribeiro@cpovo.net

Key Words: Editorials • exercise • heart failure • prognosis • respiration

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In the 19th century, Cheyne¹ and Stokes² described a pattern of periodic breathing in patients with heart failure, but over the past few decades, particular attention has been given to the occurrence of periodic breathing during sleep.^3,4 Central sleep apnea, also referred to as Cheyne-Stokes respiration, is an abnormal periodic breathing pattern in which central apneas and hypopneas alternate with periods of hyperventilation that have a waxing-waning pattern of tidal volume that classically has been associated with severe decompensated heart failure.⁴ Up to 37% of patients with heart failure may present obstructive sleep apnea,⁵ in which there is complete or partial collapse of a narrowed pharynx; as many as 40% of heart failure patients may present central sleep apnea,⁶ in which there is reduction in central inspiratory drive. Despite the fact that obstructive sleep apnea and central sleep apnea have different mechanisms, both are associated with increased sympathetic activity at night and during daytime that results in vasoconstriction, an increased peripheral vascular resistance.^3,4 Moreover, small cohort studies had previously demonstrated that the presence of central sleep apnea is associated with increased mortality in heart failure.^7,8

Article p 44

Despite the fact that cardiopulmonary exercise testing had been used in selected centers in the evaluation of heart failure since the 1960s, it was only in the mid-1980s that it became clear that patients with compensated heart failure could also have periodic ventilation at rest and during exercise.^9–11 Weber and Szidon⁹ first described an unusual "saw-toothed" ventilatory response to exercise in some . . . [Full Text of this Article]

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