title: Nocturnal dyspnea and atrial fibrillation predict Cheyne-Stokes respirations in patients with congestive heart failure.
abstract: BACKGROUND
  Cheyne-Stokes respirations have frequently been noted in highly selected groups of patients with congestive heart failure, but their prevalence in an unselected population with congestive heart failure is undefined.
  
  
  METHODS
  One hundred consecutive unselected outpatients or stable inpatients with clinical congestive heart failure encountered by three clinical cardiologists during a 6-month period were screened for Cheyne-Stokes respirations with overnight oximetry.
  
  
  RESULTS
  The mean age (+/- SD) of the patients was 70 +/- 8.6 years. Of the 100 patients, 33% had had previous coronary bypass surgery, 77% were men, 57% had hypertension, and 32% had atrial fibrillation. The mean ejection fraction (+/- SD) was 34% +/- 13%. Periodic breathing was assessed qualitatively as Cheyne-Stokes respirations in 27% of patients, nonspecific sleep-disordered breathing (apneas and/or hypopneas) in 43%, and normal in 30%. For patients with Cheyne-Stokes respirations, patients with nonspecific sleep-disordered breathing, and normal subjects, the mean numbers of oxyhemoglobin desaturation events per hour were 24, 10, and 2, and the total numbers of desaturations of 4% or more that lasted less than 3 minutes were 172, 74, and 13. Independent predictors of Cheyne-Stokes respirations vs non-Cheyne-Stokes respirations included a history of nocturnal dyspnea (odds ratio, 4.00; 95% confidence interval, 1.33 to 12.04; P = .01) and atrial fibrillation (odds ratio, 3.24; 95% confidence interval, 1.21 to 8.48; P = .02).
  
  
  CONCLUSIONS
  Cheyne-Stokes respirations and nonspecific sleep-disordered breathing are common in unselected patients with congestive heart failure, and Cheyne-Stokes respirations are predicted by a history of nocturnal dyspnea and the presence of atrial fibrillation. Techniques designed to modify the nocturnal breathing pattern of patients with congestive heart failure may be applicable to a large portion of the congestive heart failure population.
authors.affiliation: Section of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Fla, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Blackshear
authors.forename: J
authors.initials: J
authors.lastname: Kaplan
authors.forename: R C
authors.initials: RC
authors.lastname: Thompson
authors.forename: R E
authors.initials: RE
authors.lastname: Safford
authors.forename: E J
authors.initials: EJ
authors.lastname: Atkinson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D002639:Cheyne-Stokes Respiration; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011237:Predictive Value of Tests; D012307:Risk Factors; D012890:Sleep / Q000502:physiology