The Effect of Posture on Cheyne-Stokes Respirations and Hemodynamics in Patients with Heart Failure

The Effect of Posture on Cheyne-Stokes Respirations and Hemodynamics in Patients with Heart Failure

Cheyne-Stokes respirations occur in 40% of patients with heart failure. Orthopnea is a cardinal symptom of heart failure and may affect the patient's sleeping angle. The objective of this study was to assess the respiratory and hemodynamic response to sleeping angle in a group of subjects with...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) Vol. 32; no. 11; pp. 1499 - 1506
Main Authors: SOLL, Bruce A. G, KHUNG KEONG YEO, DAVIS, James W, SETO, Todd B, SCHATZ, Irwin J, SHEN, Edward N
Format: Journal Article
Language:English
Published: Darien, IL American Academy of Sleep Medicine 01-11-2009
Associated Professional Sleep Societies, LLC
Subjects:
Aged
Behavioral psychophysiology
Biological and medical sciences
Cardiography, Impedance
Cardiology. Vascular system
Cheyne-Stokes Respiration - etiology
Cheyne-Stokes Respiration - physiopathology
Cheyne-Stokes Respiration - therapy
Effects of Sleeping Posture in Heart Failure Patients
Female
Fundamental and applied biological sciences. Psychology
Heart
Heart Failure - complications
Heart Failure - physiopathology
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
Male
Medical sciences
Middle Aged
Polysomnography
Posture - physiology
Psychology. Psychoanalysis. Psychiatry
Psychology. Psychophysiology
Respiratory System - physiopathology
Single-Blind Method
Sleep - physiology
Stroke Volume
Treatment Outcome
Human
Heart failure
Heart disease
Cardiovascular disease
Hemodynamics
Respiration
Posture
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Summary:Cheyne-Stokes respirations occur in 40% of patients with heart failure. Orthopnea is a cardinal symptom of heart failure and may affect the patient's sleeping angle. The objective of this study was to assess the respiratory and hemodynamic response to sleeping angle in a group of subjects with stable heart failure. Twenty-five patients underwent overnight polysomnography with simultaneous and continuous impedance cardiographic monitoring. Sleeping polysomnographic and impedance cardiographic data were recorded. The study was conducted in a sleep center. All 25 patients had clinically stable heart failure and left ventricular ejection fractions < 40%. The patients slept at 0 degrees, 15 degrees, 30 degrees, and 45 degrees in random order. Seventeen patients had Cheyne-Stokes apneas (index > 5/h) and 23 patients had hypopneas (index > 5/h). The hypopnea index showed no response to sleeping angle. The Cheyne-Stokes apnea index decreased with increasing sleeping angle (P < 0.001). This effect was seen only during supine sleep and non-rapid eye movement sleep and was absent in non-supine sleep, rapid eye movement sleep, and during periods of wakefulness. Thoracic fluid content index and left ventricular hemodynamics measured by impedance cardiography showed no response to sleeping angle. Changing the heart failure patient's sleeping angle from 0 degrees to 45 degrees results in a significant decrease in Cheyne-Stokes apneas. This decrease occurs on a constant base of hypopneas. The changes in Cheyne-Stokes apneas are not related to changes in lung congestion and left ventricular hemodynamics.
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ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/32.11.1499