Congestive Heart FailureEffect of Cheyne-Stokes Respiration on Muscle Sympathetic Nerve Activity in Severe Congestive Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy☆
Section snippets
Subjects:
Chronic Heart Failure Patients:
We studied 14 male patients with CHF, age 60 ± 7 years (mean ± SD) (range 46 to 69). All patients had clinical, chest x-ray, and echocardiographic evidence of impaired ventricular function, and were in New York Heart Association functional classes III and IV. Left ventricular ejection fraction determined by radionuclide ventriculogram at rest was 20 ± 2% (mean ± SE). The etiology of heart failure was ischemic heart disease (n = 9) or idiopathic dilated
Results
MSNA was markedly increased in the 14 patients with CHF (52 ± 4 bursts/min) compared with the 10 age-matched control subjects (36 ± 5 bursts/min; p <0.05). Heart failure was also accompanied by a faster heart rate (75 ± 2 beats/min in the heart failure patients and 66 ± 3 beats/min in the control subjects; p <0.05) and lower mean blood pressures (75 ± 5 mm Hg in heart failure patients vs 90 ± 4 mm Hg in control subjects; p <0.01).
Oxygen saturation in control subjects was 97 ± 1%. Oxygen
Discussion
These data confirm that patients with CHF have high levels of sympathetic activity.10, 11Our novel findings are that C-S breathing, in comparison with normal spontaneous breathing, induces not only oxygen desaturation, but also elicits modest increases in sympathetic activity and induces blood pressure oscillations in patients with CHF. In addition, patients with a constant C-S breathing pattern have higher levels of sympathetic activity than patients with similar left ventricular function, in
Acknowledgements
Acknowledgment:
We thank Bridget Zimmerman, PhD, for her expert statistical analysis, and Mary Clary, RN, and Diane Davison RN, for technical assistance. We also thank Linda Bang for expert typing of this manuscript.
References (24)
- et al.
Clinical and hemodynamic correlates of sympathetic nerve activity in normal humans and patients with heart failureevidence from direct microneurographic recordings
J Am Coll Cardiol
(1990) - et al.
Sympathetic responses of patients with congestive heart failure to cold pressor stimulus
Am J Cardiol
(1991) - et al.
Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure
J Am Coll Cardiol
(1996) A case of apoplexy in which the fleshy part of the heart was converted to fat
Dublin Hospital Reports
(1818)- et al.
Occult sleep-disordered breathing in stable congestive heart failure
Ann Intern Med
(1995) - et al.
Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure
South Med J
(1985) - et al.
Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure
Am J Respir Crit Care Med
(1996) - et al.
Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure
Am Rev Respir Dis
(1989) - et al.
Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans
J Appl Physiol
(1989)
Contrasting effects of hypoxia and hypercapnia on ventilation and sympathetic activity in humans
J Appl Physiol
Sympathetic neural mechanisms in obstructive sleep apnea
J Clin Invest
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Dr. Somers was supported by an American Heart Association Grant-in-Aid; National Institute of Health grant HL14388 and Sleep Academic Award, Bethesda, Maryland. Dr. van de Borne was supported by a Fogarty Fellowship, a Belgium NATO Research Fellowship, and a J. William Fulbright Foreign Research Fellowship.