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Treatment strategies for Cheyne–Stokes respiration

T. Köhnlein, T. Welte
European Respiratory Journal 2006 27: 238; DOI: 10.1183/09031936.06.00084405
T. Köhnlein
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T. Welte
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This article has a correction. Please see:

  • “ENDOSCOPIC ULTRASOUND-GUIDED BIOPSY IN THE CHEST”. J. JANSSEN, S. GASPARINI AND A. MEHTA. EUR RESPIR J 2006; 27: 238–239. - March 01, 2006

To the Editors:

In a recent issue of the European Respiratory Journal, Gabor et al. 1 reported the effects of standard cardiac resynchronisation therapy (CRT) on nocturnal central sleep apnoea (Cheyne–Stokes respiration). CRT was shown to reduce Cheyne–Stokes respiration significantly in six out of 10 patients.

The study was performed in Canada between 1999 and 2002, which is the same era as when new generations of beta-blockers (e.g. metoprolol, carvedilol) were introduced into the market. The authors declare that the medication remained unchanged during the study, but that might be true for substance classes only and not for the type of beta-blocker. Substitution of beta-blockers had been a routine measure at that time in many industrialised countries 2.

According to our own data (currently unpublished), there seems to be a statistically significant and clinically relevant effect of high-dose beta-blocker treatment on the prevalence and severity of nocturnal central apnoeas and hypopnoeas. It could be demonstrated in three well-matched cohorts (no beta-blocker n = 16; metoprolol n = 16; carvedilol n = 13) of chronic heart failure patients (New York Heart Association II and III) that both beta-blockers, i.e. metoprolol and carvedilol, could significantly reduce the combined apnoea–hypopnoea index (19.5±14.4 versus 7.4±8.5 versus 8.7±8.1 per hour of sleep, respectively).

We suggest that the results of the study by Gabor et al. 1 should be related to the presence, dosage and type of beta-blocking medication in order to discriminate between the effects of cardiac resynchronisation therapy and potential pharmacological influences.

    • © ERS Journals Ltd

    References

    1. ↵
      Gabor JY, Newman DA, Barnard-Roberts V, et al. Improvement in Cheyne-Stokes respiration following cardiac resynchronisation therapy. Eur Respir J 2005;26:95–100.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Franciosa JA, Massie BM, Lukas MA, et al. Beta-blocker therapy for heart failure outside the clinical trial setting: findings of a community-based registry. Am Heart J 2004;148:718–726.
      OpenUrlCrossRefPubMedWeb of Science
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    Treatment strategies for Cheyne–Stokes respiration
    T. Köhnlein, T. Welte
    European Respiratory Journal Jan 2006, 27 (1) 238; DOI: 10.1183/09031936.06.00084405

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    Treatment strategies for Cheyne–Stokes respiration
    T. Köhnlein, T. Welte
    European Respiratory Journal Jan 2006, 27 (1) 238; DOI: 10.1183/09031936.06.00084405
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