Sleep–wake fluctuations and respiratory events during Cheyne–Stokes respiration in patients with heart failure

Summary Fluctuations in sleep–wake state are thought to contribute to the respiratory instability of Cheyne–Stokes respiration in patients with heart failure by promoting the rhythmic occurrence of central apnea and ventilatory overshoot. There are no data, however, on the relationship between vigil...

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Bibliographic Details
Published in:Journal of sleep research 2014-06, Vol.23 (3), p.349-359
Main Authors: Domenico Pinna, Gian, Robbi, Elena, Pizza, Fabio, Caporotondi, Angelo, Rovere, Maria Teresa, Maestri, Roberto
Format: Article
Language:English
Subjects:
Arousal - physiology
Cheyne-Stokes Respiration - complications
Cheyne-Stokes Respiration - physiopathology
Heart Failure - complications
Heart Failure - physiopathology
Humans
hybrid approach
Male
Middle Aged
Respiration
respiratory‐event diagram
Sleep - physiology
Sleep Apnea, Central - complications
Sleep Apnea, Central - physiopathology
state instability
Tidal Volume
Time Factors
Wakefulness - physiology
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Summary:Summary Fluctuations in sleep–wake state are thought to contribute to the respiratory instability of Cheyne–Stokes respiration in patients with heart failure by promoting the rhythmic occurrence of central apnea and ventilatory overshoot. There are no data, however, on the relationship between vigilance state and respiratory events. In this study we used a novel method to detect the occurrence of state transitions (time resolution: 0.25 s, minimum duration of state changes: 2 s) and to assess their time relationship with apnoeic events. We also evaluated whether end‐apnoeic arousals are associated with a ventilatory overshoot. A polysomnographic, daytime laboratory recording (25 min) was performed during Cheyne–Stokes respiration in 16 patients with heart failure. Automatic state classification included wakefulness and non‐rapid eye movement sleep stages 1–2. As a rule, wakefulness occurred during hyperpnoeic phases, and non‐rapid eye movement sleep occurred during apnoeic events. Ninety‐two percent of the observed central apneas (N = 272) were associated with a concurrent wakefulness → non‐rapid eye movement sleep → wakefulness transition. The delay between wakefulness → non‐rapid eye movement sleep transitions and apnea onset was −0.3 [−3.1, 3.0] s [median (lower quartile, upper quartile); P = 0.99 testing the null hypothesis: median delay = 0], and the delay between non‐rapid eye movement sleep → wakefulness transitions and apnea termination was 0.2 [−0.5, 1.2] s (P = 0.7). A positive/negative delay indicates that the state transition occurred before/after the onset or termination of apnea. Non‐rapid eye movement sleep → wakefulness transitions synchronous with apnea termination were associated with a threefold increase in tidal volume and a twofold increase in ventilation (all P 
ISSN:0962-1105
1365-2869
DOI:10.1111/jsr.12109