| Cheyne-Stokes respiration with central sleep apnea is a form of periodic breathing in which apneas and hypopneas alternate with ventilatory periods having a waxing-waning pattern of tidal volume. Cheyne-Stokes respiration is common among patients with chronic heart failure(CHF), being present in 40-50%. Growing evidence indicates that Cheyne-Stokes respiration is a part of the vicious pathophysiological cycle that contributes to the progression of CHF.Cheyne-Stokes respiration occurs frequently but is often unrecognised in patients with advanced CHF. In many patients, daytime fatigue and impaired physical performance is not just a symptom of the heart disease, but an indicator of sleep disordered breathing. The prognosis of patients with CHF seems to be significantly worse if Cheyne-Stokes respiration is present. Therefore, recognizing and abolishing Cheyne-Stokes respiration play an importment role in the course of CHF.Part I Sleep-disordered breathing in stable chronic congestive heart failureObjectve To determine the prevalence and effect of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure.Methods 64 patients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography (Polywin 1000, Respironics Inc.USA).Results Patients were divided into two groups. Group I (n=31,48.4%) had a rate of apnea and hypopnea (apnea-hypopnea index, AHI) of more than 15 episodes per hour,group II (n = 33) had a rate of 15 or less episodes per hour. In group I, the rate varied from 18.1 to 79.9 episodes per hour,with a average of 41.0+17.8, in which the obstructive apnea-hypopnea index was 9.9 + 7.9 and the central AHI was 31.1 + 14.1. Group I had significantly more arousals (32.3 + 13.1 compared with 14.4 + 8.1 in group II) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation during sleep [(70.4+10.6)% compared with (86.2 + 3.7)%] and lower left ventricular ejection fraction [(30.2 + 8.4)% compared with (40.9 +4.3)%].Conclusions The prevalence of sleep-disordered breathing (mainly periodic breathing or Cheyne-Stokes respiration with central sleep apnea) is high in patients with stable chronic congestive heart failure. The sleep-disordered breathing episodes areassociated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. Severe untreated sleep-disordered breathing may affect left ventricular function and could contribute to death in patients with congestive heart failure.
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