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@article{1297892,
author = {Čundrle, Ivan and Somer, Virend K. and Johnson, Bruce D. and Scott, Christopher G. and Olson, Lyle J.},
article_location = {Glenview},
article_number = {6},
doi = {http://dx.doi.org/10.1378/chest.14-2114},
keywords = {central sleep apnea; cardiopulmonary exercise testing; hypocapnea; chemosensitivity},
language = {eng},
issn = {0012-3692},
journal = {CHEST},
title = {Exercise End-Tidal CO2 Predicts Central Sleep Apnea in Patients With Heart Failure},
volume = {147},
year = {2015}
}
TY - JOUR
ID - 1297892
AU - Čundrle, Ivan - Somer, Virend K. - Johnson, Bruce D. - Scott, Christopher G. - Olson, Lyle J.
PY - 2015
TI - Exercise End-Tidal CO2 Predicts Central Sleep Apnea in Patients With Heart Failure
JF - CHEST
VL - 147
IS - 6
SP - 1566-1573
EP - 1566-1573
PB - American College of Chest Physicians
SN - 00123692
KW - central sleep apnea
KW - cardiopulmonary exercise testing
KW - hypocapnea
KW - chemosensitivity
N2 - BACKGROUND: Increased CO2 chemosensitivity and augmented exercise ventilation are characteristic of patients with heart failure (HF) with central sleep apnea (CSA). The aim of this study was to test the hypothesis that decreased end-tidal CO2 by cardiopulmonary exercise testing predicts CSA in patients with HF. METHODS: Consecutive ambulatory patients with New York Heart Association II to III HF were prospectively evaluated by CO2 chemosensitivity by rebreathe, cardiopulmonary exercise testing, and polysomnography (PSG). Subjects were classified as having either CSA (n = 20) or no sleep apnea (n = 13) by PSG; a central apnea-hypopnea index (AHI) >= 5 was used to define CSA. Subgroups were compared by t test or Mann-Whitney test and data summarized as mean +/- SD. P < .05 was considered significant. RESULTS: At rest, subjects with CSA had higher central CO2 chemosensitivity (Delta minute ventilation [(V) over dotE]/Delta partial pressure of end-tidal CO2 [PETCO2], 2.3 +/- 1.0 L/min/mm Hg vs 1.6 +/- 0.4 L/min/mm Hg, P = .02) and (V) over dotE (15 +/- 7 L/min vs 10 +/- 3 L/min, P = .02) and lower PETCO2 (31 +/- 4 mm Hg vs 35 +/- 4 mm Hg, P < .01) than control subjects. At peak exercise, the ventilatory equivalents per expired CO2 ((V) over dotE/(V) over dotCO(2)) was higher (43 +/- 9 vs 33 +/- 6, P < .01) and PETCO2 lower (29 +/- 6 mm Hg vs 36 +/- 5 mm Hg, P < .01) in subjects with CSA. In addition, CO2 chemosensitivity, peak exercise (V) over dotE/(V) over dotCO(2), and PETCO2 were independently correlated with CSA severity as quantified by the AHI (P < .05). Peak exercise PETCO2 was most strongly associated with CSA (OR, 1.29; 95% CI, 1.08-1.54; P = .01; area under the curve, 0.88). CONCLUSIONS: In patients with HF and CSA, ventilatory drive is increased while awake at rest and during exercise and associated with heightened CO2 chemosensitivity and decreased arterial CO2 set point.
ER -
ČUNDRLE, Ivan, Virend K. SOMER, Bruce D. JOHNSON, Christopher G. SCOTT a Lyle J. OLSON. Exercise End-Tidal CO2 Predicts Central Sleep Apnea in Patients With Heart Failure. \textit{CHEST}. Glenview: American College of Chest Physicians, 2015, roč.~147, č.~6, s.~1566-1573. ISSN~0012-3692. Dostupné z: https://dx.doi.org/10.1378/chest.14-2114.
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