Sleep respiratory disorders in congestive heart failure patients
Abstract
Nighttime cardiorespiratory monitoring was performed in 30 congestive heart failure (CHF) patients resulting from ischaemic heart disease, systemic arterial hypertension and dilating cardiomiopathy. The results were compared with those of obstructive sleep apnoea and hypopnoea syndrome (OSAHS) patients with no CHF signs.
Sleep disorders were found in all the patients tested. Mild to moderate OSAHS prevailed. It was determined that inspiratory and expiratory time and total tidal time were significantly reduced (p<0.05) and breathing frequency increased in the CHF patients compared to a control group. The CHF patients demonstrated an increase of a minute ventilation, a tidal volume and the mean inspiratory flow while sleep disorders became more severe. These resulted from hypoxic stimulation of the encephalic breathing center. Moreover, changes of a functional residual capacity and intraalveolar volume were found at a positive pressure end-expiration. The changes revealed can cause fatigue and weakness of respiratory muscles and disturb an intracardiac haemodynamics. So, we propose that CFH patients need CPAP-therapy during sleep.
About the Authors
I. M. VoroninRussian Federation
A. M. Belov
Russian Federation
A. G. Chuchalin
Russian Federation
References
1. Заславская Р.М., Сражат динова Н.М. Суточный ритм функции внешнего дыхания у больных с недостаточностью кровообращения. Клин. мед. 1974; 6: 77-80.
2. Чучалин А.Г., Айсанов З.Р. Нарушение функции дыхательных мышц при хронических обструктивных заболеваниях легких. Тер. арх. 1988; 8: 126-132.
3. Baertschi A.J., Teague W.G. Alveolar hypoxia is a powerful stimulus for ANF release in conscious lambs. Am. J. Physioi. 1989; 256: 990-998.
4. Brandolese R., Broseghini C., Polese G. et al. Effects of intrinsic PEEP on pulmonary gas exchange in mechanically-ventilated patients. Eur. Respir. J. 1993; 6: 358-363.
5. Conti G., Bufi M., Antonelli M. et al. Pressure support ventilation reverses hyperinflation induced isorhytmic A-V dissociation. Intensive Care Med. 1989; 15: 319-321.
6. Cournand A., Motley H.L., Werkio L., Richards D.W. Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am. J. Physiol. 1948; 52: 162-174.
7. Dhainaut J.F., Aouate P., Brunet F.P. Circulatory effect of positive end-expiratory pressure in patients with acute lung injury. In: Scharf S. M., Cassidy S. S., eds. Heart-lung interaction in health and disease. New York: Marcel Dekker; 1989. 809-838.
8. F ittin g J.W., Grassino A. Diagnosis of diaphragmatic dysfunction. Clin. Chest Med. 1987; 8: 91-103.
9. Fletcher E.C., Lesske J., Culman J. et al. Sympathetic denervation blocks blood pressure elevation in episodic hypoxia. Hypertension 1992; 20: 612-619.
10. Hedner J., Wilcox I., Laks L. et al. A specific and potent pressor effect of hypoxia in patients with sleep apnea. Am. Rev. Respir. Dis. 1992; 146: 1240-1245.
11. Krieger J., Follenius M., Sforza E., Brandenburger В. Water and electrolyte metabolism in obstructive sleep apnea. In: Horne J. A., ed. Sleep'90. Bochum: Potenagel Press; 1990: 429-434.
12. Leither C., Frass M., Pacher R. et al. Mechanical ventilation with positive end-expiratory pressure decrease release of alphaatrial natriuretic peptide. Crit. Care Med. 1987; 15: 484-488.
13. M ailla rd D., Fineyere F., Drey fuss D. et al. Pressure heart rate responses to alpha-adrenergic stimulation and hormonal regulation in normotensive patients with obstructibe sleep apnea. Am. J. Hypertens. 1997; 10: 24-31.
14. Rossi A., Gottfried S.B., Zocchi L. et al. Measurement of static compliance of the total .respiratory system in patients with acute respiratory failure during mechanical ventilation: the effect of "intrinsic PEEP". Am. Rev. Respir. Dis. 1985; 131: 672-677.
15. Rossi A., Santos S., Roca J. et al. Effects of intrinsic PEEP on ventilation-perfusion mismatching in mechanically ventilated patients with acute on chronic airway obstruction. Am. J. Respir. Crit. Care Med. 1994; 149: 1077-1084.
16. Roussos C. Ventilatory muscle fatigue governs breathing frequency. Bull. Eur. Physiopathol. Respir. 1984; 20: 445-451.
17. Schreuder J.J., Jansen J.R.C., Verspille A. Hemodynamics of PEEP applied as a ramp in normo, hyper and hypovolemia. J. Appl. Physiol. 1985; 59: 1178-1184.
18. Somers V.K., Mark A.L. Potentiation of sympathetic nerve responses to hypoxia in borderline hypertensive patients. Hypertension 1988; 11: 608-612.
Review
For citations:
Voronin I.M., Belov A.M., Chuchalin A.G. Sleep respiratory disorders in congestive heart failure patients. PULMONOLOGIYA. 2001;(2):40-44. (In Russ.)