title: Cheyne-stokes respiration during wakefulness in patients with chronic heart failure.
abstract: OBJECTIVE
  Cheyne-Stokes respiration (CSR) during sleep has been studied extensively in patients with chronic heart failure (CHF). Prevalence and prognostic significance of CSR during wakefulness in CHF, however, are largely unknown.
  
  
  METHODS
  CSR during wakefulness with an apnea-hypopnea cut-off ≥5/h and moderate to severe CSR with an apnea-hypopnea cutoff ≥15/h were analyzed using polysomnographic recordings in 267 patients with stable CHF with reduced left ventricular (LV) ejection fraction at our institution. Primary endpoint during follow-up was heart transplant-free survival.
  
  
  RESULTS
  Fifty of 267 patients (19%) had CSR during wakefulness and 73 of 267 patients (27%) had CSR during sleep. CSR during wakefulness was associated with advanced age, atrial fibrillation, decreased LV ejection fraction, increased LV end-diastolic diameter, brain natriuretic peptide, New York Heart Failure class, and CSR during sleep. During 43 months mean follow-up, 67 patients (25%) died and 4 patients (1%) underwent heart transplantation. Multivariate Cox analysis identified age, male gender, chronic kidney disease, and LV ejection fraction as predictors of reduced transplant-free survival. CSR during wakefulness with an apnea-hypopnea cutoff ≥5/h as well as moderate to severe CSR while awake using an apnea-hypopnea cutoff ≥15/h did not predict reduced transplant-free survival independently from confounding factors.
  
  
  CONCLUSIONS
  CSR during wakefulness appears to be a marker of heart failure severity.
authors.affiliation: Department of Cardiology, University Hospital of Marburg and Gießen, Marburg, Germany. grimmw@med.uni-marburg.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Grimm
authors.affiliation: Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Kesper
authors.affiliation: Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Cassel
authors.affiliation: Institute for Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Timmesfeld
authors.affiliation: Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Hildebrandt
authors.affiliation: Sleep Disorder Unit of the Department of Pneumology, University Hospital of Marburg and Gießen, Marburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Koehler
mesh_terms: D002639:Cheyne-Stokes Respiration / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology
keywords: Cheyne-stokes respiration; Heart failure; Polysomnography