Cheyne-stokes respiration and prognosis in modern-treated congestive heart failure

Abstract

In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 +/- 18 months. Mean age was 62 +/- 13 years and the mean ejection fraction was 25 +/- 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index >5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox's proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome.

Fig. 1

Cumulative proportion surviving for all patients. CSA = Cheyne-Stokes respiration; time = months; log-rank test, p = 0.25

Fig. 2

Mortality in 35 patients without biventricular pacing. CSA = Cheyne-Stokes respiration; time = months; log-rank test, p = 0.42

Fig. 3

Mortality in patients with versus without biventricular pacing. Bivent = cardiac resynchronization therapy (0 = without, 1 = with); time = months; log-rank test, p = 0.036