American Journal of Respiratory and Critical Care Medicine Vol 165. pp. 1245-1250, (2002)
© 2002 American Thoracic Society
Apnea–Hypopnea Threshold for CO2 in Patients with Congestive Heart Failure
Ailiang Xie,
James B. Skatrud,
Dominic S. Puleo,
Peter S. Rahko and
Jerome A. Dempsey
Departments of Medicine and Preventive Medicine, University of Wisconsin, and the Middleton Memorial Veterans Hospital, Madison, Wisconsin
Correspondence and requests for reprints should be addressed to Ailiang Xie, M.D., Ph.D., Pulmonary Physiology Laboratory, William S. Middleton Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705. E-mail: axie{at}facstaff.wisc.edu
To understand the pathogenesis of central sleep apnea (CSA) in patients with congestive heart failure (CHF), we measured the end-tidal carbon dioxide pressure (PETCO2) during spontaneous breathing, the apnea–hypopnea threshold for CO2, and then calculated the difference between these two measurements in 19 stable patients with CHF with (12 patients) or without (7 patients) CSA during non–rapid eye movement sleep. Pressure support ventilation was used to reduce the PETCO2 and thereby determine the thresholds. In patients with CSA, 1.5–3% CO2 was supplied temporarily to stabilize breathing before determining the thresholds. Unlike patients without CSA whose eupneic PETCO2 increased during sleep (37.7 ± 1.4 mm Hg versus 40.2 ± 1.5 mm Hg, p < 0.01), patients with CSA showed no rise in PETCO2 from wakefulness to sleep (37.5 ± 0.9 mm Hg versus 38.2 ± 1.0 mm Hg, p = 0.2). Patients with CHF and CSA had their eupneic PETCO2 closer to the threshold PETCO2 than patients without CSA ( PETCO2 [eupneic PETCO2 – threshold PETCO2] was 2.8 ± 0.3 mm Hg versus 5.1 ± 0.7 mm Hg for apnea, p < 0.01; 1.7 ± 0.7 versus 4.1 ± 0.5 mm Hg for hypopnea, p < 0.05). In summary, patients with CHF and CSA neither increase their eupneic PETCO2 during sleep nor proportionally decrease their apnea–hypopnea threshold. The resultant narrowed PETCO2 predisposes the patient to the development of apnea and subsequent breathing instability.
Key Words: congestive heart failure • apnea threshold
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