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Abstract：
Cheyne-Stokes respiration (CSR) is believed to only occur in supine and sleeping conditions, and thus, CSR treatment is applied to those specific states. Although CSR has also been described in patients with heart failure (HF) during wakefulness, its persistence in an upright position is still unknown.
The purpose of this study was to assess the predictors, clinical correlates, and prognostic value of diurnal CSR in upright position.
Outpatients with systolic HF underwent a comprehensive evaluation, including short-term respiratory monitoring with a head-up tilt test to investigate the presence of upright CSR, assessment of chemoreflex response to hypoxia and hypercapnia, and 24-h cardiorespiratory recording. At follow-up, cardiac death was considered as the endpoint.
Of 574 consecutive patients (left ventricular ejection fraction 32 ± 9%; age 65 ± 13 years; 80% men), 195 (34%) presented supine CSR only, 82 (14%) presented supine and upright CSR, and 297 patients (52%) had normal breathing. Patients with upright CSR had the greatest apnea-hypopnea and central apnea index (at daytime and nighttime), the worst hemodynamic profile and exercise performance, increased plasma norepinephrine and N-terminal pro-B-type natriuretic peptide, and chemosensitivity to hypercapnia, which was the only independent predictor of upright CSR (odds ratio: 3.96; 95% confidence interval [CI]: 1.45 to 10.76; p = 0.007 vs. normal breathing; odds ratio: 4.01; 95% CI: 1.54 to 10.46; p = 0.004 vs. supine CSR). At 8-year follow-up, patients with upright CSR had the worst outcome (log-rank = 14.05; p = 0.001) and the presence of upright CSR independently predicted 8-year cardiac death (hazard ratio: 2.39; 95% CI: 1.08 to 5.29; p = 0.032).
Upright CSR in HF patients is predicted by increased chemosensitivity to hypercapnia and is associated with worse clinical conditions and with a greater risk of cardiac death.
The purpose of this study was to assess the predictors, clinical correlates, and prognostic value of diurnal CSR in upright position.
Outpatients with systolic HF underwent a comprehensive evaluation, including short-term respiratory monitoring with a head-up tilt test to investigate the presence of upright CSR, assessment of chemoreflex response to hypoxia and hypercapnia, and 24-h cardiorespiratory recording. At follow-up, cardiac death was considered as the endpoint.
Of 574 consecutive patients (left ventricular ejection fraction 32 ± 9%; age 65 ± 13 years; 80% men), 195 (34%) presented supine CSR only, 82 (14%) presented supine and upright CSR, and 297 patients (52%) had normal breathing. Patients with upright CSR had the greatest apnea-hypopnea and central apnea index (at daytime and nighttime), the worst hemodynamic profile and exercise performance, increased plasma norepinephrine and N-terminal pro-B-type natriuretic peptide, and chemosensitivity to hypercapnia, which was the only independent predictor of upright CSR (odds ratio: 3.96; 95% confidence interval [CI]: 1.45 to 10.76; p = 0.007 vs. normal breathing; odds ratio: 4.01; 95% CI: 1.54 to 10.46; p = 0.004 vs. supine CSR). At 8-year follow-up, patients with upright CSR had the worst outcome (log-rank = 14.05; p = 0.001) and the presence of upright CSR independently predicted 8-year cardiac death (hazard ratio: 2.39; 95% CI: 1.08 to 5.29; p = 0.032).
Upright CSR in HF patients is predicted by increased chemosensitivity to hypercapnia and is associated with worse clinical conditions and with a greater risk of cardiac death.
摘要：
切恩-斯托克斯呼吸（CSR）被认为仅发生在仰卧和睡眠条件下，因此，CSR处理适用于这些特定状态。虽然在心力衰竭（HF）患者在清醒时也有CSR的描述，它的直立状态仍然未知。
这项研究的目的是评估预测因子，临床相关因素，直立体位昼夜CSR的预后价值。
对收缩期HF门诊患者进行了综合评估，包括短期呼吸监测与平头倾斜测试，以调查直立CSR的存在，对缺氧和高碳酸血症的化学反射反应的评估，和24小时心肺记录。在后续行动中,心脏死亡被认为是终点.
在574例连续患者中（左心室射血分数32±9％；年龄65±13岁；80％为男性），195（34％）仅提供仰卧CSR，82（14%）呈现仰卧和直立CSR，297例患者（52%）呼吸正常。直立CSR患者的呼吸暂停低通气和中枢呼吸暂停指数（白天和夜间）最大，最差的血液动力学特征和运动表现，血浆去甲肾上腺素和N末端B型利钠肽前体升高，和对高碳酸血症的化学敏感性，这是直立CSR的唯一独立预测因子(优势比：3.96；95%置信区间[CI]：1.45至10.76；p=0.007vs.正常呼吸；比值比：4.01；95%CI：1.54至10.46；p=0.004vs.仰卧CSR）。在8年的随访中，直立CSR患者的结局最差(log-rank=14.05;p=0.001),直立CSR的存在独立预测了8年心源性死亡(风险比:2.39;95%CI:1.08~5.29;p=0.032).
HF患者的直立CSR可通过对高碳酸血症的化学敏感性增加来预测，并且与更差的临床状况和更高的心脏死亡风险相关。
这项研究的目的是评估预测因子，临床相关因素，直立体位昼夜CSR的预后价值。
对收缩期HF门诊患者进行了综合评估，包括短期呼吸监测与平头倾斜测试，以调查直立CSR的存在，对缺氧和高碳酸血症的化学反射反应的评估，和24小时心肺记录。在后续行动中,心脏死亡被认为是终点.
在574例连续患者中（左心室射血分数32±9％；年龄65±13岁；80％为男性），195（34％）仅提供仰卧CSR，82（14%）呈现仰卧和直立CSR，297例患者（52%）呼吸正常。直立CSR患者的呼吸暂停低通气和中枢呼吸暂停指数（白天和夜间）最大，最差的血液动力学特征和运动表现，血浆去甲肾上腺素和N末端B型利钠肽前体升高，和对高碳酸血症的化学敏感性，这是直立CSR的唯一独立预测因子(优势比：3.96；95%置信区间[CI]：1.45至10.76；p=0.007vs.正常呼吸；比值比：4.01；95%CI：1.54至10.46；p=0.004vs.仰卧CSR）。在8年的随访中，直立CSR患者的结局最差(log-rank=14.05;p=0.001),直立CSR的存在独立预测了8年心源性死亡(风险比:2.39;95%CI:1.08~5.29;p=0.032).
HF患者的直立CSR可通过对高碳酸血症的化学敏感性增加来预测，并且与更差的临床状况和更高的心脏死亡风险相关。
