Breathing Pattern Abnormalities and Arterial Oxygen Desaturation during Sleep in the Congestive Heart Failure Syndrome: Improvement following Medical Therapy

doi:10.1378/chest.91.6.833

Chest

Volume 91, Issue 6, June 1987, Pages 833-836

https://doi.org/10.1378/chest.91.6.833 Get rights and content

We observed breathing pattern abnormalities and arterial oxygen desaturation in patients with stable congestive heart failure during overnight polysomnography. To determine whether congestive heart failure was the reason for these abnormalities, we then studied six additional patients before and after treatment of heart failure. Breathing was more abnormal (153 ± 87 episodes/night) during decompensation of heart failure and improved with medical therapy (72 ± 100 episodes/night) (p<0.05). Abnormal breathing patterns resolved in three patients, improved in two, and were unchanged in one patient after therapy. Allographic cardiac transplantation in one patient whose sleep study remained unchanged after medical therapy was associated with resolution of breathing pattern abnormalities and severe desaturation during sleep. Therapy-related improvement in nocturnal respiratory events suggests congestive heart failure is a contributing factor for breathing abnormalities and arterial oxygen desaturation during sleep.

Section snippets

Patient Population

Seven hospitalized patients admitted for treatment of decompensated left ventricular heart failure were studied. All underwent an overnight sleep study both on hospital admission and following medical therapy for decompensated congestive heart failure syndrome (CHFS). The syndrome was defined when classic history, physical and roentgenographic findings of left ventricular congestive heart failure were present. Selection criteria for inclusion were primary left ventricular failure in the absence

RESULTS

Six patients were studied in a decompensated state, then restudied after vigorous medical therapy for their CHFS. Five men and one woman with decompensated CHFS underwent overnight sleep study within 48 hours of hospital admission (Table 1). All patients’ conditions were diagnosed as ischemic, hypertensive, or idiopathic cardiomyopathic heart disease. The mean age was 60 ±13 years. The mean male weight was 76 ±16 kg; the female weighed 65 kg. Mean left ventricular ejection fraction was 28 ±11

DISCUSSION

Clinicians have long recognized that breathing during sleep can be abnormal in congestive heart failure. Although recent studies have documented breathing pattern abnormalities during sleep in patients with congestive heart failure,7, 8 our data are the first to document improvement in breathing pattern abnormalities following therapy for heart failure.

Our data support the concept that the sleep abnormalities found in our stable compensated patients are related to their heart failure. First,

ACKNOWLEDGMENTS

The authors wish to thank Dr. Roger Dreiling for allowing us to interview his patients, Dr. William Ruth for reviewing the manuscript, and Judy Nealy and Phyllis Swafford for secretarial assistance.

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: Manuscript received July 17; revision accepted November 19.

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Chest

Clinical InvestigationsBreathing Pattern Abnormalities and Arterial Oxygen Desaturation during Sleep in the Congestive Heart Failure Syndrome: Improvement following Medical Therapy

Section snippets

Patient Population

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

Am J Med

Chest

Lancet

Med Clin North Am

Chest

Chest

Sleep apnea, hypopnea and oxygen desaturation in normal subjects

N Engl J Med

Upper airway obstruction in obese patients with sleep disturbance and somnolence

Ann Intern Med

Clinical Investigations
Breathing Pattern Abnormalities and Arterial Oxygen Desaturation during Sleep in the Congestive Heart Failure Syndrome: Improvement following Medical Therapy