[Cheyne-Stokes respiration in patients with congestive heart failure]

Cheyne-Stokes respiration (CSR) during sleep is common in patients with severe congestive heart failure induces repetitive oxygen desaturation with arousals, and impairs sleep. This causes daytime symptoms and likely an increase in sympathetic activity. It has, therefore, been suggested that CSR is independently related to mortality. The major mechanisms behind CSR include reduced body stores of oxygen, a low apneic threshold for carbon dioxide, prolonged circulation time between the lung and the carotid body, and disturbance of respiratory control due to arousals. It is apparent that the main task in treating CSR is the therapy of congestive heart failure. Indeed, diuretics to treat pulmonary congestion as well as ACE-inhibitors reduce CSR. Recently, theophylline (an antagonist of the ventilatory depressant adenosine) was shown to reduce CSR and oxygen-desaturation. Continuous positive airway pressure did improve CSR but not sleep and may reduce cardiac output in a subgroup of patients with heart failure. Nocturnal oxygen reduces CSR and improves exercise tolerance as well as sleep. This and its apparent safety makes oxygen an appropriate treatment for nocturnal CSR. Whether successful treatment of nocturnal CSR has any impact on the natural course of heart failure needs to be determined in further studies.