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Sleep-Disordered Breathing, Heart Failure, and Phrenic Nerve StimulationHeart Failure and Phrenic Nerve Stimulation

Michelle Cao, DO, FCCP; Christian Guilleminault, MD
Author and Funding Information

From Division of Sleep Medicine, Stanford University School of Medicine.

Correspondence to: Michelle Cao, DO, FCCP, Division of Sleep Medicine, Stanford University School of Medicine, 450 Broadway St, Pavilion C, 2nd Floor, Redwood City, CA 94063; e-mail: michellecao@stanford.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):821-823. doi:10.1378/chest.12-0591
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Extract

Sleep disordered breathing (SDB), in particular obstructive sleep apnea (OSA) and central sleep apnea-Cheyne-Stokes respiration (CSA-CSR), are prevalent in patients with heart failure and are associated with poor outcome.1 OSA is characterized by repeated pharyngeal airway collapse during sleep despite ongoing respiratory effort. CSA-CSR (or periodic breathing) describes a distinct respiratory pattern characterized by crescendo-decrescendo changes in tidal volume alternating with central apneas or central hypopneas. In both disorders, repetitive cortical arousals and oxyhemoglobin desaturation are of consequence during sleep. CSA-CSR in heart failure is thought to be secondary to instability of the ventilatory system due to increased chemo-responsiveness to Paco2. OSA in heart failure is thought to be due to a narrow upper airway, obesity, possibly pharyngeal wall edema, and ventilatory control instability.

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