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June 26, 1995

Nocturnal Dyspnea and Atrial Fibrillation Predict Cheyne-Stokes Respirations in Patients With Congestive Heart Failure

Author Affiliations

From the Sections of Cardiovascular Diseases (Drs Blackshear, Thompson, and Safford) and Thoracic Diseases (Dr Kaplan), Department of Internal Medicine, Mayo Clinic Jacksonville (Fla); and the Department of Biostatistics, Mayo Clinic, Rochester, Minn (Ms Atkinson).

Arch Intern Med. 1995;155(12):1297-1302. doi:10.1001/archinte.1995.00430120081010

Background:  Cheyne-Stokes respirations have frequently been noted in highly selected groups of patients with congestive heart failure, but their prevalence in an unselected population with congestive heart failure is undefined.

Methods:  One hundred consecutive unselected outpatients or stable inpatients with clinical congestive heart failure encountered by three clinical cardiologists during a 6-month period were screened for Cheyne-Stokes respirations with overnight oximetry.

Results:  The mean age (±SD) of the patients was 70±8.6 years. Of the 100 patients, 33% had had previous coronary bypass surgery, 77% were men, 57% had hypertension, and 32% had atrial fibrillation. The mean ejection fraction (±SD) was 34%±13%. Periodic breathing was assessed qualitatively as Cheyne-Stokes respirations in 27% of patients, nonspecific sleep-disordered breathing (apneas and/or hypopneas) in 43%, and normal in 30%. For patients with Cheyne-Stokes respirations, patients with nonspecific sleep-disordered breathing, and normal subjects, the mean numbers of oxyhemoglobin desaturation events per hour were 24, 10, and 2, and the total numbers of desaturations of 4% or more that lasted less than 3 minutes were 172, 74, and 13. Independent predictors of Cheyne-Stokes respirations vs non—Cheyne-Stokes respirations included a history of nocturnal dyspnea (odds ratio, 4.00; 95% confidence interval, 1.33 to 12.04; P=.01) and atrial fibrillation (odds ratio, 3.24; 95% confidence interval, 1.21 to 8.48; P=.02).

Conclusions:  Cheyne-Stokes respirations and nonspecific sleep-disordered breathing are common in unselected patients with congestive heart failure, and Cheyne-Stokes respirations are predicted by a history of nocturnal dyspnea and the presence of atrial fibrillation. Techniques designed to modify the nocturnal breathing pattern of patients with congestive heart failure may be applicable to a large portion of the congestive heart failure population.(Arch Intern Med. 1995;155:1297-1302)