Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure

Background-Nocturnal Cheyne-Stokes respiration (CSR) occurs frequently in patients with chronic heart failure (CHF), and it may be associated with sympathetic activation. The aim of the present study was to evaluate whether CSR could affect prognosis in patients with CHF. Methods and Results-Sixty-two (CHF patients with left ventricular ejection fraction less than or equal to 35%, in NYHA class II to III, underwent clinical evaluation, Doppler echocardiography, ergospirometry, phenylephrine test, Holter recording, and a sleep study to evaluate the occurrence of CSR, expressed as percentage of periodic breathing, and apnea/hypopnea index (AHI) tie, the number of apneas and hypopneas per hour of recording). During a mean follow-up of 28 +/- 13 months, 15 patients died of cardiac causes. Nonsurvivors were in a higher NYHA functional class than survivors (P<0.001) and had a more depressed left ventricular ejection fraction (P<0.03), a shorter deceleration time of early filling (P<0.05), larger left and right atria (P<0.05 and P<0.02, respectively) and a lower peak Vo(2) (P<0.05). Nonsurvivors also spent a greater percentage of the night in periodic breathing (P<0.01) with greater AHI (P<0.03) and showed lower values of diurnal baroreflex sensitivity (P<0.05) and of heart rate variability (sdNN: P<0.01). Multivariate analysis revealed the AHI (chi(2), 10.4; P<0.01), followed by left atrial area (chi(2), 5.7; P<0.01), as the only independent and additional predictors of subsequent cardiac death. Patients at very high risk for fatal outcome could be identified by an AHI greater than or equal to 30/h and left atria greater than or equal to 25 cm(2). Conclusions-The AHI is a powerful independent predictor of poor prognosis in clinically stable patients with CHF. The presence of an AHI greater than or equal to 30/h adds prognostic information compared with other clinical, echocardiographic, and autonomic data and identifies patients at very high risk for subsequent cardiac death.