Elsevier

Sleep Medicine

Volume 10, Issue 7, August 2009, Pages 726-730
Sleep Medicine

Original Article
Pulmonary capillary wedge pressure and pulmonary arterial pressure in heart failure patients with sleep-disordered breathing

https://doi.org/10.1016/j.sleep.2008.08.004Get rights and content

Abstract

Background

There is a high prevalence of central sleep apnea (CSA) in patients with chronic heart failure (CHF). The present study investigates the hypotheses that CSA in CHF patients reflects heart failure severity as measured by cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP).

Methods

In 105 patients with stable CHF (NYHA  II, LV-EF  40%) cardiorespiratory polygraphy and simultaneous right and left heart catheterization was performed.

Results

CSA was present in 58% and obstructive sleep apnea (OSA) in 23% of patients. In CSA patients, PAP and PCWP were significantly higher when compared to patients without SDB. In CSA patients, but not in OSA patients, PCWP showed a significant correlation with apnea–hypopnea index (AHI; r = 0.41, p = 0.005), apnea index (AI; r = 0.44, p = 0.003) and central AI (cAI; r = 0.358, p = 0.015). Cardiac index was more impaired in CSA (1.93 ± 0.5 l/min/m2) than in OSA patients (2.55 ± 1.0 l/min/m2) or those without SDB (2.22 ± 0.4 l/min/m2). A negative correlation of CI and cAI (r = −0.344, p = 0.008), AI (r = −0.31, p = 0.02) and AHI (r = 0.21, p < 0.05) was documented exclusively in CSA patients.

Conclusion

The present study supports the hypotheses that the occurrence and severity of CSA in CHF patients reflects heart failure severity.

Section snippets

Background

There is a high prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure (CHF) [1], [2]. Central sleep apnea (CSA) with Cheyne–Stokes respiration (CSR), in particular, can be found in up to 40% of CHF patients treated according to current guidelines [3].

More than 50 years ago, a hypothesis was proposed by which an increase in circulation time and left ventricular dimensions lead to a destabilization in respiratory control and the development of CSA/CSR [4]. Today’s

Patients and methods

Only patients with symptomatic and stable CHF (NYHA class  II; left ventricular ejection fraction [LV-EF]  40%) treated according to current guidelines were included. In every patient, there was an indication for right and left heart catheterization independent of this study. All patients gave written informed consent the day before the investigation.

Exclusion criteria were prediagnosed or pretreated sleep-disordered breathing, decompensated heart failure, chronic obstructive lung disease,

Results

A total of 105 patients met the inclusion criteria. Demographic and clinical parameters are summarized in Table 1. Patients with CSA were significantly older than those without SDB and presented with more severe heart failure symptoms (NYHA class, nocturia). A higher body mass index (BMI) was documented in patients with OSA compared to patients without SDB or those with CSA. Heart failure was treated according to current guidelines in all patients [14].

Sleep study, blood gas analysis,

Discussion

In our cohort of consecutive patients with symptomatic CHF, those with central but not obstructive sleep apnea were characterized by more advanced heart failure symptoms (NYHA class, nocturia) and further impaired cardiac function: LV-EF, cardiac index and pulmonary artery oxygen saturation were more reduced, and pulmonary artery pressure was higher when compared to CHF patients with OSA or without SDB. In addition, there was a tendency towards more enlarged left heart diameters and volumes,

Limitations

For analysis of respiratory events at night, we used an advanced cardiorespiratory polygraphy device. These polygraphy devices have shown a high sensitivity and specificity for identifying sleep-disordered breathing [30] even in CHF patients [31]. However, given the absence of EEG recordings, the numbers of hypopneas, which are associated with arousals and not desaturation, were not captured. In addition, classifications of hypopneas into central or obstructive are based on nasal pressure

Conclusions

CHF patients with CSA are characterized by higher PAP and PCWP when compared with CHF patients with OSA or those without SDB. In our cohort, CSA patients presented with more advanced heart failure symptoms and a more impaired left ventricular function (CI, LV-EF, PA oxygen saturation). In addition, these patients tended to have higher BNP concentrations, lower oxygen uptake during CPX testing and a more reduced 6-min walking distance. These results support the hypothesis that the occurrence of

Acknowledgments

We hereby declare that the whole study was performed in consent with local ethical guidelines and German law. An explicit ethical vote was not necessary because no other than routine investigations were performed, and no additional data was generated. All investigations were performed according to GMP guidelines.

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