Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Elisa Perger, Toru Inami, Owen D Lyons, Hisham Alshaer, Stephanie Smith, John S Floras, Alexander G Logan, Michael Arzt, Joaquin Duran Cantolla, Diego Delgado, Michael Fitzpatrick, John Fleetham, Takatoshi Kasai, R John Kimoff, Richard S T Leung, Geraldo Lorenzi Filho, Pierre Mayer, Lisa Mielniczuk, Debra L Morrison, Gianfranco ParatiSairam Parthasarathy, Stefania Redolfi, Clodagh M Ryan, Frederic Series, George A Tomlinson, Anna Woo, T Douglas Bradley, ADVENT-HF Investigators

Research output: Contribution to journalArticlepeer-review


STUDY OBJECTIVES: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF.

METHODS: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed.

RESULTS: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, P < .01), longer cycle time (67.8 ± 15.9 versus 51.7 ± 9.9 seconds, P < .01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P = .01), and worse New York Heart Association class (P = .02) than those with a positive pattern. LFCT and LVEF did not differ between groups.

CONCLUSIONS: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function.

COMMENTARY: A commentary on this article appears in this issue on page 1227.

CLINICAL TRIAL REGISTRATION: The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www.clinicaltrials.gov; NCT01128816).

Original languageEnglish
Pages (from-to)1235-1241
Number of pages7
JournalJournal of Clinical Sleep Medicine
Issue number11
Publication statusPublished - Nov 15 2017


  • Journal Article


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