title: Sleep and exertional periodic breathing in chronic heart failure: prognostic importance and interdependence.
abstract: BACKGROUND
  Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown.
  
  
  RESULTS
  We studied 133 CHF patients with left ventricular ejection fraction (LVEF) < or =40%. During 1170+/-631 days of follow-up, 31 patients (23%) died. Nonsurvivors had higher New York Heart Association class, ventilatory response (ve/vco2 slope), and apnea-hypopnea index (AHI) and lower peak vo2 (all P<0.01); lower LVEF and prescription of beta-blockers, and shorter transmitral deceleration time (all P<0.05). Exertional oscillatory ventilation (EOV), established by cyclic fluctuations in minute ventilation that persisted for > or =60% of exercise duration with an amplitude > or =15% of the average resting value, was significantly more frequent in nonsurvivors (42% versus 15%, P<0.01). Multivariable analysis selected AHI (hazard ratio [HR] 5.66, 95% CI 2.3 to 19.9, P<0.01), peak vo2 (HR 0.93, 95% CI 0.90 to 0.97, P<0.01), and beta-blocker prescription (HR 0.34, 95% CI 0.13 to 0.87, P<0.05) as predictors of cardiac events. The best cutoff for AHI was >30/h. EOV was significantly related to AHI >30/h (chi2 14.6, P<0.01): 78% of EOV patients showed AHI >30/h. Multivariable analysis, including breathing disorders alone (EOV, AHI >30/h) or in combination (EOV plus AHI >30/h), selected combined disorders as the strongest predictor of events (HR 6.65, 95% CI 2.6 to 17.1, P<0.01).
  
  
  CONCLUSIONS
  In CHF, EOV is significantly associated with AHI >30/h. Although each breathing disorder alone is linked to total mortality, their combination has a crucial prognostic burden.
authors.affiliation: Divisione di Cardiologia, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy. ucorra@fsm.it
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistono
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mezzani
authors.forename: Alberto
authors.initials: A
authors.lastname: Braghiroli
authors.forename: Andrea
authors.initials: A
authors.lastname: Giordano
authors.forename: Paola
authors.initials: P
authors.lastname: Lanfranchi
authors.forename: Enzo
authors.initials: E
authors.lastname: Bosimini
authors.forename: Marco
authors.initials: M
authors.lastname: Gnemmi
authors.forename: Pantaleo
authors.initials: P
authors.lastname: Giannuzzi
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010507:Periodicity; D005082:Physical Exertion; D011379:Prognosis; D011446:Prospective Studies; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate; D017741:Survivors