Abstract 18963: Clinical Significance of Daytime Vs. Nighttime Cheyne-stokes Respiration in Systolic Heart Failure Patients: Findings From 24- Hour Polygraphic Recordings
Purpose: Cheyne Stokes respiration, that is periodic apnea/hyperpnea of central origin (CSR), has been separately described both during night (nCSR) and daytime (dCSR) in HF and associated with worse prognosis. The relationships between severity of nCSR and of dCSR have not yet been established.
Methods: we enrolled 439 consecutive HF patients (aged 65±13 years, 76% males; NYHA class III-IV 33%, LVEF: 32±9%, mean±SD) on current guideline-directed therapy (96% betablockers, 94% ACE-inhibitors/angiotensin receptor blockers, 22% CRT). All patients underwent a 24hour cardiorespiratory polygraphic recording (nasal flow plus chest and abdomen respirograms) for detection of hypo/apnea phenomenon, clinical and neurohormonal evaluation, cardiopulmonary exercise testing, echocardiography and Holter monitoring.
Results: four groups were identified according to severity of nCSR (AHI <5, 17%; mild, 5 to 15, 24%; moderate, 15 to 30, 30%; severe, >30, 29%) and dCSR (normal, apnea/hypopnea index, AHI <5, 38%; mild, 5 to 15, 32%; moderate, 15 to 30, 29%; severe, >30, 9%); nocturnal obstructive apnea prevalence (AHI >5) was 10% (1% daytime). Notably, in patients with significant (AHI>15) nCSR, dCSR had the highest prevalence (daytime AHI>15, 71%, daytime AHI>30, 26%). Both severe dCSR and nCSR were associated (p<0.01) with age, male gender, NYHA class III-IV, nonsustained ventricular tachycardia at Holter monitoring, higher plasma NT-proBNP and norepinephrine, lower pVO2, ventilatory inefficiency as assessed by the slope of ventilation to carbon dioxide production, LV dilatation (assessed by end-systolic and diastolic diameters) and hypertrophy (assessed by LV indexed mass), right ventricular dimension. Severe dCSR, but not nCSR, was associated with lower LVEF, increased prevalence of atrial fibrillation and diabetes.
Conclusions: significant dCSR is prevalent in HF, namely in patients with more severe nCSR (AHI>15). Both dCSR and nCSR are associated with neurohormonal activation, greater left and right ventricular volumes, increased ventricular arrhythmic burden and lower functional capacity, while lower LVEF as well atrial fibrillation are associated with dCSR only. Risk stratification and therapeutic strategies should consider dCSR.
Author Disclosures: G. Mirizzi: None. G. Iudice: None. F. Bramanti: None. A. Giannoni: None. R. Poletti: None. A. Gabutti: None. C. Mammini: None. V. Raglianti: None. C. Passino: None. M. Emdin: None.
- © 2014 by American Heart Association, Inc.