• T Douglas Bradley, John S Floras, Takatoshi Kasai, Dai Yumino, Derek Kimmerly, and Vinoban Amirthalingam.
• Sleep Research Laboratory, Centre for Sleep Health and Research, and Department of Medicine, University Health Network Toronto Rehabilitation Institute and Toronto General Hospital, Toronto, Ontario, Canada.
• Am. J. Respir. Crit. Care Med.. 2013 Feb 15;187(4):433-8.

RationaleObstructive sleep apnea and central sleep apnea increase risk of mortality in patients with heart failure (HF), possibly because of hemodynamic compromise during sleep. However, beat-to-beat stroke volume (SV) has not been assessed in response to obstructive and central events during sleep in patients with HF. Because obstructive events generate negative intrathoracic pressure that reduces left ventricular (LV) preload and increases afterload, but central events do not, obstructive events should lead to greater hemodynamic compromise than central events.ObjectivesTo determine the effects of obstructive and central apneas and hypopneas during sleep on SV in patients with HF.MethodsPatients with systolic HF (LV ejection fraction ≤ 45%) and sleep apnea underwent beat-to-beat measurement of SV by digital photoplethysmography during polysomnography. Change in SV from before to the end of obstructive and central respiratory events was calculated and compared between these types of events.Measurements And Main ResultsChanges in SV were assessed during 252 obstructive and 148 central respiratory events in 40 patients with HF. Whereas SV decreased by 6.8 (±8.7)% during obstructive events, it increased by 2.6 (±5.4)% during central events (P < 0.001 for difference). For obstructive events, reduction in SV was associated independently with LV ejection fraction, duration of respiratory events, and degree of oxygen desaturation.ConclusionsIn patients with HF, obstructive and central respiratory events have opposite hemodynamic effects: whereas obstructive sleep apnea appears to have an adverse effect on SV, central sleep apnea appears to have little or slightly positive effects on SV. These observations may have implications for therapeutic approaches to these two breathing disturbances.

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