TY - JOUR
T1 - Distinct patterns of hyperpnea during cheyne-stokes respiration
T2 - Implication for cardiac function in patients with heart failure
AU - Perger, Elisa
AU - Inami, Toru
AU - Lyons, Owen D.
AU - Alshaer, Hisham
AU - Smith, Stephanie
AU - Floras, John S.
AU - Logan, Alexander G.
AU - Arzt, Michael
AU - Cantolla, Joaquin Duran
AU - Delgado, Diego
AU - Fitzpatrick, Michael
AU - Fleetham, John
AU - Kasai, Takatoshi
AU - Kimoff, R. John
AU - Leung, Richard S.T.
AU - Filho, Geraldo Lorenzi
AU - Mayer, Pierre
AU - Mielniczuk, Lisa
AU - Morrison, Debra L.
AU - Parati, Gianfranco
AU - Parthasarathy, Sairam
AU - Redolfi, Stefania
AU - Ryan, Clodagh M.
AU - Series, Frederic
AU - Tomlinson, George A.
AU - Woo, Anna
AU - Bradley, T. Douglas
N1 - Funding Information:
This was a substudy of the ADVENT-HF trial that was jointly funded by the Canadian Institutes of Health Research (CIHR) and an unrestricted grant from Philips Respironics according to the regulations of the CIHR’s University Industry Program. M.A. was supported by a grant from ResMed. T.I. was supported by unrestricted research fellowships from Nippon Medical School, Tokyo, Japan, Phillips Respironics, Japan and Fukuda Foundation for Medical Technology. S.P was supported by research grants from NIH/NHLBI, Patient Centered Outcomes Research Institute, US Department of Defense and NIH (National Cancer Institute) NCI. J.S.F. was supported by a Canada Research Chair in Integrative Cardiovascular Biology. T.D.B. was supported by the Clifford Nordal Chair in Sleep Apnea and Rehabilitation Research and the Godfrey S. Pettit Chair in Respiratory Medicine. This research was performed at the University Health Network Toronto General Hospital, Toronto, Canada. All the authors have seen and approved the manuscript.
PY - 2017
Y1 - 2017
N2 - Study Objectives: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. Methods: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. Results: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, P < .01), longer cycle time (67.8 ± 15.9 versus 51.7 ± 9.9 seconds, P < .01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P = .01), and worse New York Heart Association class (P = .02) than those with a positive pattern. LFCT and LVEF did not differ between groups. Conclusions: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. Commentary: A commentary on this article appears in this issue on page 1227. Clinical Trial Registration: The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www. clinicaltrials.gov; NCT01128816).
AB - Study Objectives: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. Methods: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. Results: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, P < .01), longer cycle time (67.8 ± 15.9 versus 51.7 ± 9.9 seconds, P < .01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P = .01), and worse New York Heart Association class (P = .02) than those with a positive pattern. LFCT and LVEF did not differ between groups. Conclusions: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. Commentary: A commentary on this article appears in this issue on page 1227. Clinical Trial Registration: The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www. clinicaltrials.gov; NCT01128816).
KW - Central sleep apnea
KW - Cheyne-Stokes respiration
KW - Heart failure
KW - Hyperpnea
UR - https://www.scopus.com/pages/publications/85034089979
UR - https://www.scopus.com/pages/publications/85034089979#tab=citedBy
U2 - 10.5664/jcsm.6788
DO - 10.5664/jcsm.6788
M3 - Article
C2 - 29065956
AN - SCOPUS:85034089979
SN - 1550-9389
VL - 13
SP - 1235
EP - 1241
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 11
ER -