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Overnight Shift From Obstructive to Central Apneas in Patients With Heart Failure: Role of Pco2 and Circulatory Delay

BackgroundObstructive (OSA) and central sleep apnea (CSA) can coexist in patients with congestive heart failure (CHF). However, the reason why OSA events occur at one time and CSA events at another has not been determined. We hypothesized that a change in Pco2 would be associated with an alteration in apnea type: a decrease in Pco2 should lead to CSA. Methods and ResultsTo test this hypothesis, we evaluated minute ventilation (VI), transcutaneous Pco2 (Ptcco2), circulation time, and periodic breathing cycle length during overnight polysomnography in 12 patients with CHF and coexisting OSA and CSA. VI was significantly greater (mean±SEM, 9.4±1.3 versus 8.0±0.9 L/min;P <0.05) and Ptcco2 was lower (39.4±1.0 versus 41.9±1.1 mm Hg, P <0.01) during episodes of CSA than of OSA. These changes were associated with significant lengthening of circulation time (23.6±3.7 versus 21.1±3.6 seconds, P <0.01) and periodic breathing cycle length (53.7±3.5 versus 49.6±2.9 seconds, P <0.01). In addition, the proportion of obstructive events decreased (from 68.5±11.4% to 22.5±7.2%, P <0.001) and of CSA events increased (from 31.5±11.4% to 77.5±7.2%, P <0.001) from the first to the last quarter of the night in association with a significant decrease in Ptcco2 (from 42.6±0.9 to 40.8±0.9 mm Hg, P <0.01). ConclusionsIn patients with CHF, the shift from OSA to CSA is associated with a reduction in Pco2. This appears to be related to an overnight deterioration in cardiac function as suggested by the concurrent lengthening of circulation time. Therefore, in CHF patients, alterations in cardiac function may influence apnea type.