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Sleep Breath 2000; 04(3): 103-112
DOI: 10.1055/s-2000-11567
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Sleep-Breathing Disorders and Heart Failure

Stefan Thalhofer, Peter Dorow
  • Department of Respiratory and Intensive Care Medicine, DRK-Hospital Mark Brandenburg, Humboldt University of Berlin, Berlin, Germany
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

Cheyne-Stokes respiration is known to be associated with severe left heart failure. Because of severe desaturation, sleep fragmentation, arousals, and an increase in sympathetic activity, Cheyne-Stokes respiration may lead to a further impairment of cardiac function and to a worsening of quality of life. Although the pathology of Cheyne-Stokes respiration is not fully understood, enhanced chemoreceptor sensitivity, prolonged circulation time, as well as decreased pulmonary gas stores and increased ventilatory drive may be contributing factors. Therapeutic options include the improvement of cardiac failure; medical treatment, such as using theophylline; continous positive airway pressure ventilation; and low-flow oxygen supply. Because of severe cardiac insufficiency, change of endothoracic pressure may worsen the hemodynamic situation in some patients. Therefore, this form of treatment has to be used carefully. Another possible treatment is a low-flow oxygen supply, which will prevent severe desaturations. This therapeutic approach might be a good alternative to noninvasive ventilation. However, it is controversial whether oxygen supply will improve quality of sleep of the patients, even in long-term treatment.

KEYWORD

sleep apnea - Cheyne-Stokes respiration - chronic heart failure - dilated cardiomyopathy - congestive heart failure - oygen therapy - continous positive airway pressure (CPAP) - theophylline

REFERENCES

  • 1 Yamashiro Y, Kryger M H. Sleep in heart failure.  Sleep . 1993;  16 513-523
    PubMedSearch in Google Scholar
  • 2 Cheyne J A. A case of apoplexy in which the fleshy part of the heart was converted into fat.  Dublin Hospital Reports . 1818;  2 216-222
    PubMedSearch in Google Scholar
  • 3 Stokes W. The diseases of the heart and the aorta. Dublin, Hodges and Smith 1854: 302-40
    Search in Google Scholar
  • 4 Douglas G S, Haldane J S. The causes of periodic or Cheyne-Stokes breathing.  J Physiol . 1909;  38 401-419
    PubMedSearch in Google Scholar
  • 5 Harrison T R, King C E, Calhoun J A, Harrison Jr G W. Congestive heart failure: Cheyne-Stokes respiration as a cause of paroxysmal dyspnea at the onset of sleep.  Arch Intern Med . 1934;  53 891-910
    PubMedSearch in Google Scholar
  • 6 Greene J A. Clinical studies of respiration: some observations on Cheyne-Stokes respiration.  Arch Intern Med . 1934;  52 454-463
    PubMedSearch in Google Scholar
  • 7 Biot C. Etude Clinique et Experimental sur La Respiration de Cheyne-Stokes.  Paris: JB Baillie 1878
    Search in Google Scholar
  • 8 Marckwald M. The Movements of Respiration and Their Innervation in The Rabbit.  London: Blackie & Son 1888
    Search in Google Scholar
  • 9 Eyster J AE. Clinical and experimental observations upon Cheyne-Stokes respiration.  J Exp Med . 1906;  8 565-613
    CrossrefPubMedSearch in Google Scholar
  • 10 Grimmer R V, Hesser F H, Longworthy O R. Rhythmic variation of respiratory excursions with bilateral injury of cortical efferent fibers.  Arch Neurol Psychiatry . 1939;  42 862-871
    PubMedSearch in Google Scholar
  • 11 Findley L J, Zwillich C W, Ancoli-Israel S, Kripke D, Tisi G, Moser K M. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure.  South Med J . 1985;  78 11-15
    PubMedSearch in Google Scholar
  • 12 Hanly P J, Fillar T WN, Steljes D G, Baert R, Frais M A, Kryger M H. Respiration and abnormal sleep in patients with congestive heart failure.  Chest . 1989;  96 480-488
    PubMedSearch in Google Scholar
  • 13 Thalhofer S, Dorow P, Schüler S, Hetzer R. Sauerstoffsättigung und Schlafarchitektur bei Patienten mit dilatativer Kardiomyopathie.  Pneumologie . 1991;  5 259-260
    PubMedSearch in Google Scholar
  • 14 Dowell A R, Buckley C E, Cohen R, Whalen R E, Sieker H O. Cheyne-Stokes respiration. A review of clinical manifestations and critique of physiological mechanisms.  Arch Intern Med . 1971;  127 712-726
    CrossrefPubMedSearch in Google Scholar
  • 15 Lieber C V, Mohsenin V. Cheyne-Stokes respiration in congestive heart failure.  Yale J Biol Med . 1992;  65 39-50
    PubMedSearch in Google Scholar
  • 16 Andreas S, Breska B, Siegener M S, Figulla H R, Kreuzer H. Respiration during sleep in patients with ideopathic dilated cardiomyopathy [abstract].  Am Rev Respir Dis . 1992;  145 A446
    PubMedSearch in Google Scholar
  • 17 Dowdell W T, Javaheri S, McGinnis W. Cheyne-Stokes respiration presenting as sleep apnea syndrome.  Am Rev Respir Dis . 1990;  141 871-879
    PubMedSearch in Google Scholar
  • 18 Hanly P J, Millar T W, Steljes D G, Baert R, Frais M A, Kryger M H. Respiration and abnormal sleep in patients with congestive heart failure.  Chest . 1989;  96 480-488
    PubMedSearch in Google Scholar
  • 19 Yasuma F, Nomura H, Hayashi H, Okada T, Tsuzuki M. Breathing abnormalities during sleep in patients with chronic heart failure.  Jpn Circ J . 1989;  1 506-510
    PubMedSearch in Google Scholar
  • 20 Takasaki Y, Orr D, Popkin J, Rutherford R, Liu P P, Bradley T D. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure.  Am Rev Respir Dis . 1989;  140 1578-1584
    PubMedSearch in Google Scholar
  • 21 Malone S, Liu P P, Holloway R, Rutherford R, Xie A, Bradley T D. Obstructive sleep apnoea in patients with dilated cardiomyopathy effects of continuous positive airway pressure.  Lancet . 1991;  338 1480-1484
    CrossrefPubMedSearch in Google Scholar
  • 22 Alex C, Önal E, Lopata M. Upper airway occlusion during sleep in patients with Cheyne-Stokes respiration.  Am Rev Respir Dis . 1986;  133 42-45
    PubMedSearch in Google Scholar
  • 23 Campbell E JM, Howell J B. Proprioceptive control of breathing. In: de Rüch AUS, O'Connor M, eds. Ciba Foundation Symposium on Pulmonary Structure and Function Edinburgh: Churchill Livingstone; 1962
    Search in Google Scholar
  • 24 Berger A J. Control of respiration. In: Physiology and Biophysics Philadelphia: WB Saunders 1987
    Search in Google Scholar
  • 25 Klein O. Untersuchungen über das Cheyne-Stokesche Atmungsphänomen.  Desch Ges Inn Med . 1930;  42 217
    PubMedSearch in Google Scholar
  • 26 Naughton M, Benard D, Tam A, Rutherford R, Bradley T D. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure.  Am Rev Respir Dis . 1993;  148 330-338
    CrossrefPubMedSearch in Google Scholar
  • 27 Millar T W, Hanly P J, Hunt B, Frais M, Kryger M H. The entrainment of low frequency breathing periodicity.  Chest . 1990;  98 1143-1148
    PubMedSearch in Google Scholar
  • 28 Guyton A C, Crowell J W, Moore J W. Basic oscillating mechanism of Cheyne-Stokes breathing.  Am J Physiol . 1956;  187 395-398
    PubMedSearch in Google Scholar
  • 29 Lange R L, Hecht H H. The mechanism of Cheyne-Stokes respiration.  J Clin Invest . 1962;  41 42-52
    PubMedSearch in Google Scholar
  • 30 Weil J V, Kryger M H, Scoggin C. Sleep and breathing at high altitude. In: Guilleminault CW, Dement C, eds. Sleep Apnea Syndomes New York:Alan R. Liss, 1978: 119-135
    Search in Google Scholar
  • 31 Bradley T D, Holloway R M, McLaughin P R, Ross B L, Walters J, Liu P P. Cardiac output response to continous positive airway pressure in congestive heart failure.  Am Rev Respir Dis . 1992;  145 377-382
    PubMedSearch in Google Scholar
  • 32 Reed J W, Ablett M, Cotes J E. Ventilatory responses to exercises and to carbon dioxide in mitral stenosis before and after valvulotomy: causes of tachypnoea.  Clin Sci Mol Med . 1978;  54 9-15
    PubMedSearch in Google Scholar
  • 33 Bradley T D, Floras J S. Pathophysiology and therapeutic implications of sleep anea in congestive heart failure.  J Card Fail . 1996;  2 223-240
    PubMedSearch in Google Scholar
  • 34 Ambrosino N, Opasich C, Crotti P, Cobelli F, Tavazzi L, Rampulla C. Breathing pattern, ventilatory drive and respiratory muscle strength in patients with chronic heart failure.  Eur Respir J . 1994;  7 17-22
    CrossrefPubMedSearch in Google Scholar
  • 35 Sullivan M, Higgenbottam M, Cobb F. Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities.  Circulation . 1988;  77 552-559
    PubMedSearch in Google Scholar
  • 36 Altschule M D, Iglauer A. The effect of portion on peridic breathing in chronic cardiac decompensation.  N Engl J Med . 1958;  27 1064-1066
    PubMedSearch in Google Scholar
  • 37 Massumi R, Nutter D. Cardiac arrhythmias associated with Cheyne-Stokes respiration.  J Dis Chest . 1968;  54 21-32
    PubMedSearch in Google Scholar
  • 38 Maze S, Kotler M N, Parry W R. Doppler evaluation of changing cardiac dynamics during Cheyne-Stokes respiration.  Chest . 1989;  95 525-529
    PubMedSearch in Google Scholar
  • 39 Javaheri S, Parker T J, Liming J D. Sleep apnea in 81 ambulatory male patients with stable heart failure.  Circulation . 1998;  97 2154-2159
    PubMedSearch in Google Scholar
  • 40 Bradley T D. Right and left ventricular functional impairment and sleep apnea.  Clin Chest Med . 1992;  13 459-479
    PubMedSearch in Google Scholar
  • 41 Lanfranchi P A, Bragholi A, Bosimini E, Mazzuero G, Colombo R, Donner C F. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure.  Circulation . 1999;  11 1435-1440
    PubMedSearch in Google Scholar
  • 42 Hoffman R, Agatston A, Krieger B. Cheyne-Stokes respiration in patients recovering from acute cardiogenic pulmonary edema.  Chest . 1990;  97 410-412
    PubMedSearch in Google Scholar
  • 43 Findley L J, Zwillich C W, Ancoli-Israel S, Kripke D, Tisi G, Moser K M. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure.  South Med J . 1985;  78 11-15
    CrossrefPubMedSearch in Google Scholar
  • 44 Baylor P, Tayloe D, Owen D, Sanders C. Cardiac failure presenting as sleep apnea. Elimination of apnea following medical management of cardiac failure.  Chest . 1988;  94 1298-1300
    PubMedSearch in Google Scholar
  • 45 Crabb J E, Pingleton S K, Gollub S. Sleep disordered breathing (SDB) in decompensated and compensated congestive heart failure [abstract].  Am Rev Respir Dis . 1985;  131 A104
    PubMedSearch in Google Scholar
  • 46 Dark D S, Pingleton S K, Kerby G R. Breathing pattem abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome.  Chest . 1987;  91 833-836
    CrossrefPubMedSearch in Google Scholar
  • 47 Bittar G, Friedman H S. The arrhythrogenicity of theophylline. A multivariate analysis of clinical determinants.  Chest . 1991;  99 1415-1420
    PubMedSearch in Google Scholar
  • 48 Guilleminault C, Clerk A, Labanowski M, Simmons J, Stoohs R. Cardiac failure and benzodiazepines.  Sleep . 1993;  16 524-528
    PubMedSearch in Google Scholar
  • 49 Biberdorf D J, Steens R, Millar T W, Kryger M H. Benzodiazepines in congestive heart failure: effects of temazepam on arousability and Cheyne-Stokes respiration.  Sleep . 1993;  16 529-538
    PubMedSearch in Google Scholar
  • 50 Andreas S, Plopck E H, Heindl S, Scholz K. Nasal oxygen effects on arterial carbon dioxide pressure and heart rate in chronic heart failure.  Am J Cardiol . 1999;  83 795-798
    CrossrefPubMedSearch in Google Scholar
  • 51 Hardy J C, Gray K, Whistler S, Leuenberger U. Sympathetic and blood pressure responses to voluntary apnea are augmented by hypoxemia.  J Appl Physiol . 1994;  77 2360-2365
    CrossrefPubMedSearch in Google Scholar
  • 52 Lahiri S, Mokashi A, Mulligan E, Nishino T. Comparison of aortic and carotic chemoreceptors response to hypercapnia and hyperoxia.  J Appl Physiol . 1981;  51 55-61
    PubMedSearch in Google Scholar
  • 53 Seals D R, Johnson D G, Fregosi R F. Hyperoxia lowers sympathetic activity at rest but not during exercise in humans.  Am J Physiol . 1991;  260 873-878
    PubMedSearch in Google Scholar
  • 54 Dorow P, Thalhofer S, Schüler S, Hetzer R. Einfluβ der nasalen Überdruckbeatmung bei Patienten mit dilatativer Kardiomyopathie (NYHA III-IV).  Pneumologie . 1993;  47 780-781
    PubMedSearch in Google Scholar
  • 55 Naughton M T, Liu P P, Bernard D C, Goldstein R S, Bradley T D. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continous positive airway pressure.  Am J Respir Crit Care Med . 1995;  151 92-97
    CrossrefPubMedSearch in Google Scholar
  • 56 Davies R J, Harrington K J, Ormerod O J, Stradling J R. Nasal continous positive airway pressure in chronic heart failure with sleep-disordered breathing.  Am J Respir Crit Care Med . 1993;  147 630-634
    PubMedSearch in Google Scholar
  • 57 Thalhofer S, Dorow P. Influence of nasal positive pressure ventilation on hemodynamics in patients with severe dilatative cardiomyopathy (NYHA III-IV).  Sleep breathing . 1996;  1 9-14
    PubMedSearch in Google Scholar
  • 58 Baratz D M, Westbrook P R, Shah P K, Mohsenifar Z. Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure.  Chest . 1992;  102 1397-1401
    PubMedSearch in Google Scholar
  • 59 Javaheri S. Effects of continous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure.  Circulation . 2000;  101 392-397
    PubMedSearch in Google Scholar
  • 60 Naughton M T, Bernard D C, Liu P P, Rutherford R, Rankin F, Bradley T D. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea.  Am J Respir Crit Care Med . 1995;  152 473-479
    CrossrefPubMedSearch in Google Scholar
  • 61 Tkacova R, Liu P P, Naughton M T, Bernard D C, Bradley T D. Effects of continous positive airway pressure on atrial natriuretic peptide and mitral regurgitant fraction in patients with heart failure and central sleep apnea.  J Am Coll Cardiol . 1997;  30 739-745
    CrossrefPubMedSearch in Google Scholar
  • 62 Steens R D, Biberdorf D, Buckle P, Ahmed M, Millar T, Kryger M H. Effect of inhaled 3%CO2 on Cheyne-Stokes respiration in congestive heart failure [abstract].  Am Rev Respir Dis . 1992;  145 A445
    PubMedSearch in Google Scholar