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Sleep Breath (2011) 15:827835 DOI 10.1007/s11325-010-0444-2
ORIGINAL ARTICLE
Predictors of oxidative stress in heart failure patients with CheyneStokes respiration
Ana C. Krieger & Daniel Green & Muriel T. Cruz &
Frank Modersitzki & Gita Yitta & Sanja Jelic &
Doris S. Tse & Steven P. Sedlis
Received: 18 July 2010 /Revised: 6 October 2010 /Accepted: 1 November 2010 /Published online: 20 November 2010 # Springer-Verlag 2010
AbstractPurpose CheyneStokes respiration during sleep is associated with increased mortality in heart failure. The magnitude of oxidative stress is a marker of disease severity and a valuable predictor of mortality in heart failure. Increased oxidative stress associated with periodic breathing during CheyneStokes respiration may mediate increased mortality in these patients. We hypothesized that the presence of CheyneStokes respiration is associated with oxidative stress by increasing the formation of reactive oxygen species in patients with heart failure.Methods and results Twenty-three patients with heart failure [left ventricular ejection fraction 30.29% (meanstandard deviation)] and 11 healthy controls underwent nocturnal polysomnography. Subjects with obstructive sleep apnea were
excluded. The majority (88%) of patients with heart failure had CheyneStokes respiration during sleep. The intensity of oxidative stress in neutrophils was greater in patients with heart failure (4,2181,706 mean fluorescence intensity/cell vs. 1,003348 for controls, p<0.001) and correlated with the duration of CheyneStokes respiration. Oxidative stress was negatively correlated with SaO2 nadir during sleep (r=0.43, p=0.039). The duration of CheyneStokes respiration predicted severity of oxidative stress in patients with heart failure (beta=483 mean fluorescence intensity/cell, p<0.02). Conclusions Levels of oxidative stress are increased in patients with heart failure and CheyneStokes respiration during sleep compared with healthy controls. The duration of CheyneStokes respiration predicts the magnitude of oxidative stress in heart failure. Increased oxidative stress may mediate increased mortality associated with Cheyne Stokes respiration in patients with heart failure.
Keywords Oxidative stress . Heart failure . Cheyne-stokes respiration . Periodic breathing . Hypoxemia . Sleep apnea
CheyneStokes respiration, the predominant form of sleep-related respiratory disturbance in patients with heart failure, is characterized by alternating periods of crescendo and decrescendo respiration followed by central apneas [15]. Unlike obstructive sleep apnea, which occurs due to airway obstruction, CheyneStokes respiration is caused by oscillations in central respiratory control. Little is known about the effects of altered central respiratory control...