Heart 1998;79:394-399 ( April )

Nocturnal desaturation in patients with stable heart failure

A D Staniforth,^a W J M Kinnear,^b R Starling,^c A J Cowley^a

^a Department of Cardiovascular Medicine, Queens Medical Centre, Nottingham, UK, ^b Department of Respiratory Medicine, Queens Medical Centre, ^c Department of Neurophysiology, Queens Medical Centre

Correspondence to: Dr A D Staniforth, Specialist Registrar in Cardiology, Newham General Hospital, Glen Road, Plaistow, London E13 8SL, UK.

Accepted for publication 16 December 1997

ObjectiveTo determine the prevalence of sleep disordered breathing within a United Kingdom heart failure population.
Subjects104 patients and 21 matched normal volunteers.
MethodsOvernight home pulse oximetry with simultaneous ECG recording in the patient group; daytime sleepiness was assessed using the Epworth sleepiness scale (ESS); 41 patients underwent polysomnography to assess the validity of oximetry as a screening test for Cheyne-Stokes respiration.
ResultsHome oximetry was a good screening test for Cheyne-Stokes respiration (specificity 81%, sensitivity 87%). Patients with poorer New York Heart Association (NYHA) classes had higher sleepiness scores (p < 0.005). Twenty three patients had "abnormal" patterns of nocturnal desaturation suggestive of Cheyne-Stokes respiration. The mean (SEM) frequency of dips in SaO₂ exceeding 4% was 10.3 (0.9) per hour in the patients and 4.8 (0.6) in normal controls (p < 0.005). Ejection fraction correlated negatively with dip frequency (r = 0.5. p < 0.005). The patient subgroup with  15 dips/hour had a higher mean (SEM) NYHA class (3.0 (0.2) v 2.3 (0.1), p < 0.05), and experienced more ventricular ectopy (220 (76) v 78 (21) beats/hour, p < 0.05). There was no excess of serious arrhythmia.
ConclusionsNocturnal desaturation is common in patients with treated heart failure. Low ejection fraction was related to dip frequency. Lack of correlation between dips and ESS suggests that arousal from sleep is more important than hypoxia in the aetiology of daytime sleepiness in heart failure. Overnight oximetry is a useful screening test for Cheyne-Stokes respiration in patients with known heart failure.

Keywords: Cheyne-Stokes respiration;  nocturnal desaturation;  heart failure

---

© 1998 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Hjalmarsen, A., Hykkerud, D. L. (2008). Severe nocturnal hypoxaemia in geriatric inpatients. Age Ageing 37: 526-529 [Abstract] [Full Text]  
• Garcia-Touchard, A., Somers, V. K., Olson, L. J., Caples, S. M. (2008). Central Sleep Apnea: Implications for Congestive Heart Failure. Chest 133: 1495-1504 [Abstract] [Full Text]  
• Vazir, A., Dayer, M., Hastings, P. C., McIntyre, H. F., Henein, M. Y., Poole-Wilson, P. A., Cowie, M. R., Morrell, M. J., Simonds, A. K. (2006). Can heart rate variation rule out sleep-disordered breathing in heart failure?. Eur Respir J 27: 571-577 [Abstract] [Full Text]  
• Staniforth, A D, Sporton, S C, Early, M J, Wedzicha, J A, Nathan, A W, Schilling, R J (2005). Ventricular arrhythmia, Cheyne-Stokes respiration, and death: observations from patients with defibrillators. Heart 91: 1418-1422 [Abstract] [Full Text]  
• Series, F., Kimoff, R. J., Morrison, D., Leblanc, M. H., Smilovitch, M., Howlett, J., Logan, A. G., Floras, J. S., Bradley, T. D. (2005). Prospective Evaluation of Nocturnal Oximetry for Detection of Sleep-Related Breathing Disturbances in Patients With Chronic Heart Failure. Chest 127: 1507-1514 [Abstract] [Full Text]  
• Quintana-Gallego, E., Villa-Gil, M., Carmona-Bernal, C., Botebol-Benhamou, G., Martinez-Martinez, A., Sanchez-Armengol, A., Polo-Padillo, J., Capote, F. (2004). Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure. Eur Respir J 24: 443-448 [Abstract] [Full Text]  
• Javaheri, S. (2003). Pembrey's Dream: The Time Has Come for a Long-term Trial of Nocturnal Supplemental Nasal Oxygen to Treat Central Sleep Apnea in Congestive Heart Failure. Chest 123: 322-325 [Full Text]  
• Kohnlein, T., Welte, T., Tan, L.B., Elliott, M.W. (2002). Assisted ventilation for heart failure patients with Cheyne-Stokes respiration. Eur Respir J 20: 934-941 [Abstract] [Full Text]  
• Staniforth, A D, Kinnear, W J M, Cowley, A J (2001). Cognitive impairment in heart failure with Cheyne-Stokes respiration. Heart 85: 18-22 [Abstract] [Full Text]  
• Andreas, S. (1999). Nocturnal insights in chronic heart failure. Eur Heart J 20: 1140-1141  
• RITTER, G. (1998). Nocturnal desaturation in patients with stable heart failure. Heart 80: 633b-634 [Full Text]