Download PDF
Dtsch Med Wochenschr 2014; 139(19): 1009-1014
DOI: 10.1055/s-0034-1369809
Übersicht | Review article
Kardiologie, Pneumologie
© Georg Thieme Verlag KG Stuttgart · New York

Cheyne-Stokes-Atmung bei Patienten mit chronischer Herzinsuffizienz: nur diagnostischer „Marker“ oder auch kardialer Risikofaktor?

Cheyne-Stokes respiration in patients with chronic heart failure: only a diagnostic marker or also a cardiovascular risk factor?
U. Koehler
1   Klinik für Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin
,
O. Hildebrandt
1   Klinik für Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin
,
C. Nell
1   Klinik für Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin
,
K. Thiem
1   Klinik für Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin
,
E. Sibai
1   Klinik für Innere Medizin, Schwerpunkt Pneumologie, Intensiv- und Schlafmedizin
,
V. Gross
2   Biomedizinische Technik, Fachbereich KMUB (Krankenhaus- und Medizintechnik, Umwelt- und Biotechnologie), Technische Hochschule Mittelhessen, Gießen
,
W. Grimm
3   Klinik für Innere Medizin, Schwerpunkt Kardiologie und Angiologie, Philipps-Universität Marburg
› Author Affiliations
Further Information

Publication History

04 July 2013

21 November 2013

Publication Date:
29 April 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Schlafbezogene obstruktive und zentrale Atmungsstörungen sind bei Patienten mit chronischer Herzinsuffizienz häufig zu finden, werden jedoch hinsichtlich ihrer klinischen Bedeutung unterschätzt. Mit dem Schweregrad der Herzinsuffizienz geht eine erhöhte Frequenz und Dauer zentraler Atmungsstörungen, insbesondere der Cheyne-Stokes-Atmung (CSA), einher. Die CSA ist gekennzeichnet durch ein wiederholt auftretendes Crescendo-Descrescendo Atemmuster mit konsekutiver zentraler Apnoe. Sie muss als Prädiktor für eine erhöhte Mortalität angesehen werden. Die durch die Atmungsstörung induzierte erhöhte sympathische Aktivität ist sowohl für die Progression der Grunderkrankung als auch deren Prognose bedeutsam.

Abstract

Sleep disordered breathing with predominant obstructive or central apnea is an under-recognized but highly prevalent comorbidity in patients with chronic heart failure. As the severity of heart failure increases the prevalence of central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) is also much more frequent. Cheyne-Stokes respiration is characterized by alternating periods of crescendo and decrescendo respiration followed by central apnea. Present data indicate that CSA-CSR is not only a compensatory response to severe heart failure but also a predictor of worse prognosis. However the results on long-term mortality are not consistent. The prognostic importance of night- and daytime CSR has to be further elucidated. Increased sympathetic nervous activity has been proposed to play a mayor role concerning progression and outcome of chronic heart failure by CSA-CSR.

Schlüsselwörter

zentrale Schlafapnoe - Cheyne-Stokes-Atmung - chronische Herzinsuffizienz - Mortalität

Keywords

central sleep apnea - Cheyne-Stokes respiration - chronic heart failure - mortality risk
 

  • Literatur

  • 1 Aldabal L, BaHammam AS. Cheyne-Stokes Respiration in patients with heart failure. Lung 2010; 188: 5-14
    CrossrefPubMedGoogle Scholar
  • 2 Amir O, Barak-Shinar D, Wolff R et al. Long-term assessment of nocturnal Cheyne-Stokes respiration in patients with heart failure. Sleep Breath 2011; 15: 855-860
    CrossrefPubMedGoogle Scholar
  • 3 Amir O, Reisfeld D, Sberro H et al. Implications of Cheyne-Stokes breathing in advanced systolic heart failure. Clin Cardiol 2010; 33: 8-12
    PubMedGoogle Scholar
  • 4 Andreas S, Hagenah G, Möller C et al. Cheyne-Stokes respiration in congestive heart failure. Am J Cardiol 1996; 78: 1260-1264
    CrossrefPubMedGoogle Scholar
  • 5 Berry RB, Budhiraja R, Gottlieb DJ et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the scoring of sleep and associated events. J of Clin Sleep Med 2012; 8: 597-619
    PubMedGoogle Scholar
  • 6 Bitter T, Westerheide N, Prinz C et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J 2011; 32: 61-74
    CrossrefPubMedGoogle Scholar
  • 7 Brack T, Thüer I, Clarenbach CF et al. Daytime Cheyne-Stokes-Respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality. Chest 2007; 132: 1463-1471
    CrossrefPubMedGoogle Scholar
  • 8 Brack T, Randerath W, Bloch KE. Cheyne-Stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments. Respiration 2012; 83: 165-176
    CrossrefPubMedGoogle Scholar
  • 9 Cherniack NS, Longobardo G, Evangelista CJ. Causes of Cheyne-Stokes respiration. Neurocrit Care 2005; 3: 271-279
    CrossrefPubMedGoogle Scholar
  • 10 Christ M, Sharkova Y, Fenske H et al. Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients. Int J of Cardiology 2007; 116: 62-69
    PubMedGoogle Scholar
  • 11 Corra U, Pistono M, Mezzani A. Sleep and exertional periodic breathing in chronic heart failure. Prognostic importance and interdependence. Circulation 2006; 113: 44-50
    CrossrefPubMedGoogle Scholar
  • 12 Damy T, Margarit L, Noroc A et al. Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 2012; 14: 1009-1019
    CrossrefPubMedGoogle Scholar
  • 13 Findley LJ, Zwillich CW, Ancoli-Israel S et al. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure. South Med J 1985; 78: 11-15
    CrossrefPubMedGoogle Scholar
  • 14 Hall MJ, Xie A, Rutherford R et al. Cycle length of periodic breathing in patients with and without heart failure. Am J Repir Crit Care Med 1996; 154: 376-381
    CrossrefPubMedGoogle Scholar
  • 15 Hanley PJ, Zuberi-Khokhar NS. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure. Am J Respir Crit Care Med 1996; 153: 272-276
    CrossrefPubMedGoogle Scholar
  • 16 Javaheri S, Parker TJ, Liming JD et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Circulation 1998; 97: 2154-2159
    CrossrefPubMedGoogle Scholar
  • 17 Javaheri S. Sleep disorders in systolic heart failure: A prospective study of 100 male patients. The final report. Int J of Cardiology 2006; 106: 21-28
    PubMedGoogle Scholar
  • 18 Javaheri S, Shukla R, Zeigler H et al. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol 2007; 49: 2028-2034
    CrossrefPubMedGoogle Scholar
  • 19 Joho S, Oda Y, Hirai T et al. Impact of sleeping position on central sleep apnea/Cheyne-Stokes respiration in patients with heart failure. Sleep Medicine 2010; 11: 143-148
    CrossrefPubMedGoogle Scholar
  • 20 Khayat R, Abraham W, Patt B et al. Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Cardiac Fail 2012; 18: 534-540
    CrossrefPubMedGoogle Scholar
  • 21 Koehler U, Apelt S, Cassel W et al. Schlafbezogene Atmungsstörungen und maligne ventrikuläre Arrhythmien bei Patienten mit chronischer Herzinusffizienz. Wien Klin Wochenschr 2012; 124: 63-68
    CrossrefPubMedGoogle Scholar
  • 22 Krieger AC, Green D, Cruz MT et al. Predictors of oxidative stress in heart failure patients with Cheyne-Stokes respiration. Sleep Breath 2011; 15: 827-835
    CrossrefPubMedGoogle Scholar
  • 23 Lanfranchi PA, Braghiroli A, Bosimini E et al. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation 1999; 99: 1435-1440
    CrossrefPubMedGoogle Scholar
  • 24 Lanfranchi PA, Somers VK, Braghiroli A et al. Central sleep apnea in left ventricular dysfunction. Prevalence and implications for arrhythmic risk. Circulation 2003; 107: 727-732
    CrossrefPubMedGoogle Scholar
  • 25 Luo Q, Zhang HL, Tao XC et al. Impact of untreated sleep apnea on prognosis of patients with congestive heart failure. Int J Cardiol 2010; 144: 420-422
    CrossrefPubMedGoogle Scholar
  • 26 Lüthje L, Renner B, Kessels T et al. Cardiac resynchronisation therapy and atrial overdrive pacing for the treatment of central sleep apnoea. Eur J of Heart Failure 2009; 11: 273-280
    PubMedGoogle Scholar
  • 27 Mansfield D, Kaye DM, Brunner La Rocca H et al. Raised sympathetic nerve activity in heart failure and central sleep apnea is due to heart failure severity. Circulation 2003; 107: 1396-1400
    CrossrefPubMedGoogle Scholar
  • 28 Naughton MT, Benard DC, Liu PP et al. 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
    CrossrefPubMedGoogle Scholar
  • 29 Naughton MT. Cheyne-Stokes respiration: friend or foe. Thorax 2012; 67: 357-360
    CrossrefPubMedGoogle Scholar
  • 30 Oldenburg O, Lamp B, Faber L et al. Sleep disordered breathing in patients with symptomatic heart failure. A contemporary study of prevalence in and characteristics of 700 patients. Eur J of Heart Failure 2007; 9: 251-257
    PubMedGoogle Scholar
  • 31 Oldenburg O. Cheyne-Stokes respiration in chronic heart failure – treatment with adaptive servoventilation therapy. Circ J 2012; 76: 2305-2317
    CrossrefPubMedGoogle Scholar
  • 32 Pepin JL, Chouri-Pontarollo N, Tamisier R et al. Cheyne-Stokes respiration with central sleep apnoea in chronic heart failure: proposals for a diagnostic and therapeutic strategy. Sleep Med Rev 2006; 10: 33-47
    CrossrefPubMedGoogle Scholar
  • 33 Roebuck T, Solin P, Kaye DM et al. Increased long-term mortality in heart failure due to sleep apnea is not yet proven. Eur Respir J 2004; 23: 735-740
    CrossrefPubMedGoogle Scholar
  • 34 Silva RS, Figueiredo AC, Mady C et al. Breathing disorders in congestive heart failure: gender, etiology and mortality. Braz J Biol Res 2008; 41: 215-222
    PubMedGoogle Scholar
  • 35 Sin DD, Fitzgerald F, Parker JD et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999; 160: 1101-1106
    CrossrefPubMedGoogle Scholar
  • 36 Sin DD, Logan AG, Fitzgerald FS et al. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation 2000; 102: 61-66
    CrossrefPubMedGoogle Scholar
  • 37 Solin P, Bergin P, Richardson M et al. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 1999; 99: 1574-1579
    CrossrefPubMedGoogle Scholar
  • 38 Tkacova R, Niroumand M, Lorenzo-Filho G et al. Overnight shift from obstructive to central apneas in patients with heart failure: role of pCO2 and circulatory delay. Circulation 2001; 103: 238-243
    CrossrefPubMedGoogle Scholar
  • 39 Vazir A, Hastings PC, Dayer M et al. A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Europ J of Heart Failure 2007; 9: 243-250
    PubMedGoogle Scholar
  • 40 Wedewardt J, Bitter T, Prinz C et al. Cheyne-Stokes respiration in heart failure: Cycle length is dependent on left ventricular ejection fraction. Sleep Med 2010; 11: 137-142
    CrossrefPubMedGoogle Scholar
  • 41 Xie A, Skatrud JB, Puleo DS et al. Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol 2001; 91: 1555-1562
    CrossrefPubMedGoogle Scholar