Association of low PaCO2 with central sleep apnea and ventricular arrhythmias in ambulatory patients with stable heart failure.
نویسندگان
چکیده
BACKGROUND Central sleep apnea frequently occurs in patients with heart failure. Because it is not practical to perform sleep studies on all patients, readily available laboratory tests that predict sleep apnea would be clinically useful. Arterial PCO2 has a profound influence on breathing during sleep: When it decreases below a certain threshold, apnea occurs. OBJECTIVE To study the value of a low PaCO2 while patients are awake in predicting central sleep apnea in patients with stable, treated heart failure. DESIGN Prospective study. SETTING Referral sleep laboratory of a Department of Veterans Affairs Medical Center. PARTICIPANTS 59 patients with left ventricular ejection fractions of 45% or less. MEASUREMENTS Arterial blood gases and hydrogen ion concentrations were measured, and cardiac radionuclide ventriculography, Holter monitoring, and polysomnography were done. RESULTS Patients were classified as eucapnic (PaCO2 > 35 and < 44 mm Hg [n = 41]) or hypocapnic (PaCO2 < or = 35 mm Hg [n = 18]). The mean (+/- SD) hourly episodes of apnea or hypopnea (36 +/- 25 and 20 +/- 27; P = 0.015), the prevalence of central sleep apnea (78% and 39%; P = 0.01), and the mean hourly occurrences of ventricular tachycardia (2 +/- 3 and 0.1 +/- 0.1; P = 0.003) were significantly greater in hypocapnic patients than in eucapnic patients. CONCLUSION Data on patients with heart failure in this study are consistent with the physiologic notion that a low PaCO2 results in ventilatory instability and central apnea during sleep. The positive predictive value of a low PaCO2 for central sleep apnea is 78%. The prevalence of ventricular tachycardia was 20 times greater in hypocapnic patients than in eucapnic patients.
منابع مشابه
Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations.
BACKGROUND Heart failure is a highly prevalent disorder that continues to be associated with repeated hospitalizations, high morbidity, and high mortality. Sleep-related breathing disorders with repetitive episodes of asphyxia may adversely affect heart function. The main aims of this study were to determine the prevalence, consequences, and differences in various sleep-related breathing disord...
متن کاملCan chronotropic incompetence predict life-threatening ventricular arrhythmias in patients with stable ischemic heart disease?
Background: Chronotropic incompetence has prognostic value of all-cause and cardiovascular mortality in both patients with asymptomatic and symptomatic ischemic heart disease (IHD), regardless of traditional risk factors. The aim of this study was to investigate the relationship between chronotropic response during exercise test and the development of ventricular arrhythmias. Methods: 153 pati...
متن کاملProbability of obstructive sleep apnea in male patients with systolic heart failure and some related factors
Background and Purpose: Sleep breathing disorders have a negative impact on the illness outcome and quality of life in patients with heart failure. This study was conducted to investigate the probability of obstructive sleep apnea in men with heart failure and some related factors. Method: This was a cross-sectional study conducted on 100 male patients with systolic heart failure selected throu...
متن کاملAssociation of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure.
The prevalence and characteristics of sleep-disordered breathing (SDB) in patients with ventricular arrhythmias, such as premature ventricular complexes and ventricular tachycardia, are unknown. Therefore, this study was conducted to evaluate the prevalence of SDB in patients with severe ventricular arrhythmias and normal left ventricular (LV) function. Thirty-five patients (63% men, mean age 5...
متن کاملThe effects of curcumin on the prevention of atrial and ventricular arrhythmias and heart failure in patients with unstable angina: A randomized clinical trial
Objective: Inflammation along with oxidative stress has an important role in the pathophysiology of unstable angina which leads to acute myocardial infarction, arrhythmias and eventually heart failure. Curcumin has anti-inflammatory and anti-oxidant effects and thereby, it may reduce cardiovascular complications. This randomized controlled trial aimed to investigate the effects of curcumin on t...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Annals of internal medicine
دوره 128 3 شماره
صفحات -
تاریخ انتشار 1998