Influence of Low-Flow Oxygen Supply on Sleep Architecture in Patients with Severe Heart Failure (NYHA III-IV) and Cheyne-Stokes Respiration

ABSTRACT

Patients suffering from severe heart failure may develop breathing pattern disorders during sleep, especially in the form of Cheyne-Stokes respiration. Results may be severe disturbances in sleep architecture and worsening of hemodynamics and of prognosis of these patients. Causes of the periodic breathing disorders are probably hypocapnia, hypersensitivity of respiratory control centers, hypoxemia, and prolonged blood circulation time. This study examined the influence of different concentrations of continously administered oxygen during the nighttime on breathing pattern disorders, oxygen saturation, and sleep architecture in 65 patients with severe heart failure (NYHA III-IV). Fifty-two of 65 patients showed an improvement of sleep architecture. Total sleeping time increased significantly (p < 0.01). Fragmentations of sleep by arousals decreased ( p < 0.01); time of random eye movement (REM) sleep and non-REM sleep III and IV increased significantly.

KEYWORD

Cheyne-Stokes respiration - dilated cardiomyopathy - congestive heart failure - oxygen supply - sleep architecture

REFERENCES

• 1 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
• 2 Stokes W. The diseases of the heart and the aorta.  Dublin Hodges and Smith. 1854;  302-340
• 3 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 failure.  South Med J . 1985;  78 11-15
• 4 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
• 5 Hanly P J, Millar T W, Steljes D G, Baert R, Frais M A, Kryger M H. The effect of oxygen on respiration and sleep in patients with congestive heart failure.  Ann Intern Med . 1989;  111 777-782
• 6 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
• 7 Thalhofer S, Gronemeyer S, Dorow P. Einfluss einer Sauerstofflangzeittherapie auf die Schlafarchitektur bei Patienten mit schwerer dilatativer Kardiomyopathie und Cheyne-Stokes Atmung.  Pneumologie . 1997;  51 740-743
• 8 Andreas S, v Breska B, Kopp E, Figulla H R, Kreuzer H. Periodic respiration in patients with heart failure.  Clin Invest . 1993;  71 281-285
• 9 Thalhofer S, Dorow P, Schüler S, Hetzer R. Sauerstoffsättigung und Schlafarchitektur bei Patienten mit dilatativer Cardiomyopathie.  Pneumologie . 1991;  45 259-260
• 10 Braghiroli L, de Vito F, Sacco C. Effects of periodic breathing on polysomnographic findings in patients with congestive heart failure [abstract].  Am Rev Respir Dis . 1992;  145 A445
• 11 Dark D, Pingleton S K, Kerby G R. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome: Improvement with medical therapy.  Chest . 1987;  91 833-836
• 12 Brown H W, Plum F. The neurological basis of Cheyne-Stokes respiration.  Am J Med . 1961;  102 31-35
• 13 Davies R J, Harrington K J, Omerod O J, Stradling J R. Nasal continous airway pressure in chronic heart failure with sleep-disordered breathing.  Am Rev Respir Dis . 1993;  147 630-634
• 14 Dowdell W T, Javaheri S, McGinnis W. Cheyne-Stokes respiration presenting as sleep apnea syndrome.  Am Rev Respir Dis . 1990;  141 871-879
• 15 Guilleminault C, Clerk A, Labanowski M, Simmons J, Stoohs R. Cardiac failure and benzodiazepines.  Sleep . 1993;  16 524-528
• 16 Takasaki Y, Orr D, Popkin J, Rutherford R, Liu P P, Bradley T. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure.  Am Rev Respir Dis . 1989;  140 1578-1584
• 17 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
• 18 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
• 19 Berssenbrugge A, Dempsey J, Iber C, Skatrud J, Wilson P. Mechanisms of hypoxia-induced periodic breathing during sleep in humans.  J Physiol (Lond) . 1983;  343 529-538
• 20 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
• 21 Staniforth A D, Kinnear W JM, Starling R, Hetmanski D J, Cowley A J. Effect of oxygen on sleep qualitiy, cognitive function and sympathetic activity in patients with chronic heart failure and Cheyne-Stokes respiration.  Eur Heart J . 1998;  19 922-9281