Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: Clinical implications and role of augmented peripheral chemosensitivity
Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathin...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1999-12, Vol.100 (24), p.2418-2424 |
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| creator | PONIKOWSKI, P ANKER, S. D TUAN PENG CHUA FRANCIS, D BANASIAK, W POOLE-WILSON, P. A COATS, A. J. S PIEPOLI, M |
| description | Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity.
To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L. min(-1). %SaO(2)(-1), P |
| doi_str_mv | 10.1161/01.CIR.100.24.2418 |
| format | Article |
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To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L. min(-1). %SaO(2)(-1), P<0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (P=0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, P<0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (P=0.04).
An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.100.24.2418</identifier><identifier>PMID: 10595954</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Analgesics, Opioid - administration & dosage ; Autonomic Nervous System - physiology ; Biological and medical sciences ; Cardiology. Vascular system ; Cheyne-Stokes Respiration - physiopathology ; Chronic Disease ; Codeine - administration & dosage ; Codeine - analogs & derivatives ; Female ; Follow-Up Studies ; Heart ; Heart Failure - physiopathology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Heart Rate ; Humans ; Male ; Medical sciences ; Middle Aged ; Oxygen - administration & dosage ; Oxygen Consumption ; Periodicity ; Postural Balance ; Pressoreceptors - drug effects ; Pressoreceptors - physiology ; Prognosis ; Prospective Studies ; Respiratory Mechanics - drug effects ; Respiratory Mechanics - physiology ; Wakefulness</subject><ispartof>Circulation (New York, N.Y.), 1999-12, Vol.100 (24), p.2418-2424</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Dec 14, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-46865a442a28e933f7dd00e4557700068f7fe9ed5de3008886fe062d21b36fd53</citedby><cites>FETCH-LOGICAL-c398t-46865a442a28e933f7dd00e4557700068f7fe9ed5de3008886fe062d21b36fd53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1225795$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10595954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PONIKOWSKI, P</creatorcontrib><creatorcontrib>ANKER, S. D</creatorcontrib><creatorcontrib>TUAN PENG CHUA</creatorcontrib><creatorcontrib>FRANCIS, D</creatorcontrib><creatorcontrib>BANASIAK, W</creatorcontrib><creatorcontrib>POOLE-WILSON, P. A</creatorcontrib><creatorcontrib>COATS, A. J. S</creatorcontrib><creatorcontrib>PIEPOLI, M</creatorcontrib><title>Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: Clinical implications and role of augmented peripheral chemosensitivity</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity.
To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L. min(-1). %SaO(2)(-1), P<0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (P=0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, P<0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (P=0.04).
An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing.</description><subject>Aged</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Autonomic Nervous System - physiology</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cheyne-Stokes Respiration - physiopathology</subject><subject>Chronic Disease</subject><subject>Codeine - administration & dosage</subject><subject>Codeine - analogs & derivatives</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart Failure - physiopathology</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Oxygen - administration & dosage</subject><subject>Oxygen Consumption</subject><subject>Periodicity</subject><subject>Postural Balance</subject><subject>Pressoreceptors - drug effects</subject><subject>Pressoreceptors - physiology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Respiratory Mechanics - drug effects</subject><subject>Respiratory Mechanics - physiology</subject><subject>Wakefulness</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd9qFDEUxoModlt9AS8kiHg32_yZZGa8k0VroVCQeh2yk5NO6kwyJhnLPo5vaoZdsJQEki_5nY_kfAi9o2RLqaSXhG531z-2lJAtq8uk7Qu0oYLVVS149xJtCCFd1XDGztB5Sg9FSt6I1-iMEtGVUW_Q39vUu3HUOcQD3kfQeXD-Hs86Z4g-YbPEVT_qX2CX0UNK2Pn12oHPCT-6POB-iMG7Hg-gY8ZWu3GJ8BnvRldO9YjdNI9lk10ohtobHMMIOFisl_up2IDBM0Q3DxAL3Q8whQQ-uez-uHx4g15ZPSZ4e1ov0M9vX-9236ub26vr3Zebquddm6tatlLoumaatdBxbhtjCIFaiKZZP97axkIHRhjghLRtKy0QyQyjey6tEfwCfTr6zjH8XiBlNbnUQ-mNh7AkJTsuaEtW8MMz8CEs0Ze3KUaZbCiRskDsCPUxpBTBqjm6SceDokSt6SlCVUmvSKJYrdb0StH7k_Oyn8A8KTnGVYCPJ0Cn0lkbte9d-s8xJppO8H_6VKXd</recordid><startdate>19991214</startdate><enddate>19991214</enddate><creator>PONIKOWSKI, P</creator><creator>ANKER, S. D</creator><creator>TUAN PENG CHUA</creator><creator>FRANCIS, D</creator><creator>BANASIAK, W</creator><creator>POOLE-WILSON, P. A</creator><creator>COATS, A. J. S</creator><creator>PIEPOLI, M</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19991214</creationdate><title>Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: Clinical implications and role of augmented peripheral chemosensitivity</title><author>PONIKOWSKI, P ; ANKER, S. D ; TUAN PENG CHUA ; FRANCIS, D ; BANASIAK, W ; POOLE-WILSON, P. A ; COATS, A. J. S ; PIEPOLI, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-46865a442a28e933f7dd00e4557700068f7fe9ed5de3008886fe062d21b36fd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Autonomic Nervous System - physiology</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cheyne-Stokes Respiration - physiopathology</topic><topic>Chronic Disease</topic><topic>Codeine - administration & dosage</topic><topic>Codeine - analogs & derivatives</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart Failure - physiopathology</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Oxygen - administration & dosage</topic><topic>Oxygen Consumption</topic><topic>Periodicity</topic><topic>Postural Balance</topic><topic>Pressoreceptors - drug effects</topic><topic>Pressoreceptors - physiology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Respiratory Mechanics - drug effects</topic><topic>Respiratory Mechanics - physiology</topic><topic>Wakefulness</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PONIKOWSKI, P</creatorcontrib><creatorcontrib>ANKER, S. D</creatorcontrib><creatorcontrib>TUAN PENG CHUA</creatorcontrib><creatorcontrib>FRANCIS, D</creatorcontrib><creatorcontrib>BANASIAK, W</creatorcontrib><creatorcontrib>POOLE-WILSON, P. A</creatorcontrib><creatorcontrib>COATS, A. J. S</creatorcontrib><creatorcontrib>PIEPOLI, M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PONIKOWSKI, P</au><au>ANKER, S. D</au><au>TUAN PENG CHUA</au><au>FRANCIS, D</au><au>BANASIAK, W</au><au>POOLE-WILSON, P. A</au><au>COATS, A. J. S</au><au>PIEPOLI, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: Clinical implications and role of augmented peripheral chemosensitivity</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1999-12-14</date><risdate>1999</risdate><volume>100</volume><issue>24</issue><spage>2418</spage><epage>2424</epage><pages>2418-2424</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity.
To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L. min(-1). %SaO(2)(-1), P<0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (P=0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, P<0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (P=0.04).
An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>10595954</pmid><doi>10.1161/01.CIR.100.24.2418</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Ovid Autoload; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Analgesics, Opioid - administration & dosage Autonomic Nervous System - physiology Biological and medical sciences Cardiology. Vascular system Cheyne-Stokes Respiration - physiopathology Chronic Disease Codeine - administration & dosage Codeine - analogs & derivatives Female Follow-Up Studies Heart Heart Failure - physiopathology Heart failure, cardiogenic pulmonary edema, cardiac enlargement Heart Rate Humans Male Medical sciences Middle Aged Oxygen - administration & dosage Oxygen Consumption Periodicity Postural Balance Pressoreceptors - drug effects Pressoreceptors - physiology Prognosis Prospective Studies Respiratory Mechanics - drug effects Respiratory Mechanics - physiology Wakefulness |
| title | Oscillatory breathing patterns during wakefulness in patients with chronic heart failure: Clinical implications and role of augmented peripheral chemosensitivity |
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