Cardiovascular medicine
Cognitive impairment in heart failure with Cheyne-Stokes
respiration
A D Stanifortha, W J M Kinnearb, A J Cowleya
a Department of
Cardiovascular Medicine, Queens Medical Centre, Nottingham, UK, b Department of
Respiratory Medicine, Queens Medical Centre
Correspondence to: Dr A D Staniforth, Specialist Registrar in Cardiology, St Bartholemew's Hospital, West Smithfield, London EC1 7BE, UK
Accepted 11 September
2000
OBJECTIVES
To document the degree of
cognitive impairment in stable heart failure, and to determine its
relation to the presence of Cheyne-Stokes respiration during sleep.
SUBJECTS104 heart failure patients
and 21 healthy normal volunteers.
METHODSOvernight oximetry was used
(previously validated as a screening tool for Cheyne-Stokes respiration
in heart failure). Cognitive function was assessed using a battery of
neuropsychological tests. Left ventricular function was assessed by echocardiography.
RESULTSHeart failure patients
performed worse than the healthy volunteers in tests that measured
vigilance. Reaction times were 48% slower (0.89 (0.03) s
v 0.60 (0.05) s; p < 0.005) and they hit twice as many obstacles on the Steer Clear simulator (75 (6.4) v 33 (4.6); p < 0.005). Cognitive
impairment within the heart failure group was unrelated to either the
presence of Cheyne-Stokes respiration, the degree of left ventricular
dysfunction, or indices of nocturnal oxygenation.
CONCLUSIONSVigilance was impaired in
heart failure but this did not appear to be related to the presence of
Cheyne-Stokes respiration during sleep. Impaired vigilance as measured
on the Steer Clear test has been associated with an increased risk of
motor vehicle accidents. The issue of fitness to drive in heart failure
requires further attention.
Keywords: Cheyne-Stokes respiration; cognitive function; heart failure; driving
© 2001 by Heart
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