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