Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure

被引:174
作者
Sinha, AM
Skobel, EC
Breithardt, OA
Norra, C
Markus, KU
Breuer, C
Hanrath, P
Stellbrink, C
机构
[1] Rhein Westfal TH Aachen Klinikum, Univ Hosp, Med Klin 1, Dept Cardiol, D-52074 Aachen, Germany
[2] Rhein Westfal TH Aachen Klinikum, Univ Hosp, Clin Psychiat & Psychotherapy, D-52074 Aachen, Germany
关键词
D O I
10.1016/j.jacc.2004.03.040
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA). BACKGROUND Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown. METHODS Twenty-four patients (7 females; 62 +/- 11 years) with HF, a reduced left ventricular ejection fraction (24 +/- 6%), and left bundle branch block (QRS duration 173 +/- 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (Sao(2)min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 7 weeks of CRT. RESULTS In patients with CSA, CRT led to a significant decrease in AHI (19.2 +/- 10.3 to 4.6 +/- 4.4, p < 0.001) and PSQI (10.4 +/- 1.6 to 3.9 +/- 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in Sao(2)min (84 +/- 5% to 89 +/- 2%, p < 0.001). There was no significant change in AHI (1.7 +/- 0.7 to 1.5 +/- 1.6), PSQI (2.4 +/- 0.5 to 2.6 +/- 0.9), and Sao(2)min (90 +/- 2% to 91 +/- 1%) in patients without CSA. CONCLUSIONS Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications inpatients receiving. (C) 2004 by the American College of Cardiology Foundation.
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页码:68 / 71
页数:4
相关论文
共 22 条
[11]   Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research [J].
Flemons, WW ;
Buysse, D ;
Redline, S ;
Pack, A ;
Strohl, K ;
Wheatley, J ;
Young, T ;
Douglas, N ;
Levy, P ;
McNicholas, W ;
Fleetham, J ;
White, D ;
Schmidt-Nowarra, W ;
Carley, D ;
Romaniuk, J .
SLEEP, 1999, 22 (05) :667-689
[12]   Benefit of atrial pacing in sleep apnea syndrome [J].
Garrigue, S ;
Bordier, P ;
Jaïs, P ;
Shah, DC ;
Hocini, M ;
Raherisson, C ;
De Lara, MT ;
Haïssaguerre, M ;
Clementy, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (06) :404-412
[13]   Cycle length of periodic breathing in patients with and without heart failure [J].
Hall, MJ ;
Xie, AL ;
Rutherford, R ;
Ando, SI ;
Floras, JS ;
Bradley, TD .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1996, 154 (02) :376-381
[14]   A mechanism of central sleep apnea in patients with heart failure [J].
Javaheri, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (13) :949-954
[15]   Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure [J].
Javaheri, S .
CIRCULATION, 2000, 101 (04) :392-397
[16]   Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure [J].
Lanfranchi, PA ;
Braghiroli, A ;
Bosimini, E ;
Mazzuero, G ;
Colombo, R ;
Donner, CF ;
Giannuzzi, P .
CIRCULATION, 1999, 99 (11) :1435-1440
[17]   Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation [J].
Leite, JJ ;
Mansur, AJ ;
de Freitas, HFG ;
Chizola, PR ;
Bocchi, EA ;
Terra, M ;
Neder, JA ;
Lorenzi, G .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (12) :2175-2181
[18]   Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy [J].
Mortara, A ;
Sleight, P ;
Pinna, GD ;
Maestri, R ;
Capomolla, S ;
Febo, O ;
La Rovere, MT ;
Cobelli, F .
AMERICAN JOURNAL OF CARDIOLOGY, 1999, 84 (08) :900-904
[19]   Comparison of impedance minute ventilation and direct measured minute ventilation in a rate adaptive pacemaker [J].
Simon, R ;
Ni, Q ;
Willems, R ;
Hartley, JW ;
Daum, DR ;
Lang, D ;
Ward, K ;
Gill, J .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2003, 26 (11) :2127-2133
[20]   Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration [J].
Sin, DD ;
Logan, AG ;
Fitzgerald, FS ;
Liu, PP ;
Bradley, TD .
CIRCULATION, 2000, 102 (01) :61-66