This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200208-793OCv1 167/11/1534    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leung, R. S. T. Articles by Bradley, T. D. Search for Related Content PubMed PubMed Citation Articles by Leung, R. S. T. Articles by Bradley, T. D.

Influence of Cheyne-Stokes Respiration on Cardiovascular Oscillations in Heart Failure

Sleep and Cardiovascular Physiology Research Laboratories of the Mount Sinai Hospital, Departments of Medicine of the Mount Sinai Hospital, and Toronto General Hospital/University Health Network, and the Center for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada

Correspondence and requests for reprints should be addressed to T. Douglas Bradley, M.D., Toronto General Hospital/UHN, NU 9–112, 200 Elizabeth Street, Toronto ON, M5G 2C4, Canada. E-mail: douglas.bradley{at}utoronto.ca

In patients with congestive heart failure, Cheyne-Stokes respiration is accompanied by oscillations in blood pressure and heart rate at a very low frequency. It is not known whether these cardiovascular oscillations are primarily related to oscillations in ventilation or oxyhemoglobin saturation. We hypothesized that abolition of the ventilatory oscillations of Cheyne-Stokes respiration by CO₂ inhalation would eliminate accompanying oscillations in blood pressure and heart rate but that elimination of hypoxic dips by supplemental O₂ would not. We studied 10 subjects with heart failure and Cheyne-Stokes respiration during sleep using frequency spectral analysis. During Cheyne-Stokes respiration, heart rate and blood pressure oscillated in association with respiratory oscillations at very low frequency. Inhalation of CO₂ abolished Cheyne-Stokes respiration and associated oscillations in both blood pressure and heart rate. In contrast, inhalation of O₂ sufficient to eliminate hypoxic dips had no significant effect on Cheyne-Stokes respiration, blood pressure (n = 6), or heart rate (n = 5). We conclude that ventilatory oscillations during Cheyne-Stokes respiration rather than oscillations in oxygenation per se powerfully induce heart rate and blood pressure oscillations. Cheyne-Stokes respiration is therefore one of the mechanisms that contributes to the very low-frequency oscillations in heart rate and blood pressure observed in patients with heart failure.

Key Words: central sleep apnea • heart rate variability • blood pressure variability

This article has been cited by other articles:

				G. Lorenzi-Filho and P. R. Genta A New Straw in the Genesis of Cheyne-Stokes Respiration Chest, July 1, 2008; 134(1): 7 - 9. [Full Text] [PDF]

				M. Arzt, R. Wensel, S. Montalvan, T. Schichtl, S. Schroll, S. Budweiser, F. C. Blumberg, G. A. J. Riegger, and M. Pfeifer Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men With Heart Failure Chest, July 1, 2008; 134(1): 61 - 66. [Abstract] [Full Text] [PDF]

				J Amit Benjamin and K E Lewis Sleep-disordered breathing and cardiovascular disease Postgrad. Med. J., January 1, 2008; 84(987): 15 - 22. [Abstract] [Full Text] [PDF]

				M. Arzt, J. S. Floras, A. G. Logan, R. J. Kimoff, F. Series, D. Morrison, K. Ferguson, I. Belenkie, M. Pfeifer, J. Fleetham, et al. Suppression of Central Sleep Apnea by Continuous Positive Airway Pressure and Transplant-Free Survival in Heart Failure: A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP) Circulation, June 26, 2007; 115(25): 3173 - 3180. [Abstract] [Full Text] [PDF]

				M. Arzt and T. D. Bradley Treatment of Sleep Apnea in Heart Failure Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1300 - 1308. [Abstract] [Full Text] [PDF]

				A. Vazir, M. Dayer, P. C. Hastings, H. F. McIntyre, M. Y. Henein, P. A. Poole-Wilson, M. R. Cowie, M. J. Morrell, and A. K. Simonds Can heart rate variation rule out sleep-disordered breathing in heart failure? Eur. Respir. J., March 1, 2006; 27(3): 571 - 577. [Abstract] [Full Text] [PDF]

				R. S. T. Leung, M. E. Bowman, T. M. Diep, G. Lorenzi-Filho, J. S. Floras, and T. D. Bradley Influence of Cheyne-Stokes respiration on ventricular response to atrial fibrillation in heart failure J Appl Physiol, November 1, 2005; 99(5): 1689 - 1696. [Abstract] [Full Text] [PDF]

				K. G. Johnson and D. C. Johnson Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep Chest, October 1, 2005; 128(4): 2141 - 2150. [Abstract] [Full Text] [PDF]

				M. J. Tobin Sleep-Disordered Breathing, Control of Breathing, Respiratory Muscles, Pulmonary Function Testing in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 254 - 264. [Full Text] [PDF]