PMID- 17761455
OWN - NLM
STAT- MEDLINE
DCOM- 20081211
LR  - 20131121
IS  - 1389-9457 (Print)
IS  - 1389-9457 (Linking)
VI  - 9
IP  - 4
DP  - 2008 May
TI  - Monitoring of ventilation during the early part of cardiopulmonary exercise 
      testing: the first step to detect central sleep apnoea in chronic heart failure.
PG  - 411-7
AB  - BACKGROUND AND PURPOSE: To evaluate the prediction of nocturnal central sleep 
      apnoea (CSA) syndrome from the presence of periodic breathing (PB) on diurnal 
      monitoring of pre-exercise (cardiopulmonary exercise test [CPX]) parameters. CSA 
      syndrome is commonly found in congestive heart failure (CHF) patients and has 
      several prognostic and therapeutic implications but is frequently undiagnosed. 
      Awake PB pattern is sometimes observed during the CPX cardiopulmonary monitoring 
      period of gas exchanges in CHF patients referred to the stress test laboratory 
      for routine peak VO2 determination. PATIENTS AND METHODS: Forty-five consecutive 
      ambulatory patients (2 women/43 men; 60.2+/-11.7 years old) with clinically 
      moderate to severe CHF (New York Heart Association [NYHA] class II/III: 22/23; 
      mean+/-standard deviation left ventricular ejection fraction [LVEF]: 30.5+/-6.6%) 
      underwent a classical maximal CPX test including a 2-min period (pre-test) of gas 
      exchange monitoring and nocturnal ambulatory polygraphic monitoring. PB was 
      defined when a cyclical pattern of VE, VO2, VCO2, was visually noted during the 
      pre-exercise period and/or during the first 4 min of the CPX. CSA syndrome was 
      retained as a central apnoea-plus-hypopnea index (cAHI) equal to or more than 
      10/h. The sleep study scoring procedure was done independently of the knowledge 
      of the CPX results. Sensitivity, specificity and predictive values were 
      calculated and receiver operating characteristic (ROC) curve analysis was 
      constructed. RESULTS: Peak VO2 reached 16.4+/-5.2 mL kg(-1)min(-1) (55% of the 
      theoretical value adjusted for gender and age). The polygraphy was completed and 
      validated (at least five consecutive hours of sleep) in all cases. CSA syndrome 
      was found in 28 (62%) patients (mean cAHI: 19.3+/-8.6/h). Sensitivity for the 
      prediction of CSA syndrome reached 92.9% (two false-negative patients with a cAHI 
      of nine) and specificity 94.1% with a predictive accuracy of 93.3%. The only 
      false-positive patient suffered a moderate but significant obstructive sleep 
      apnoea syndrome. Using ROC curve analysis, the W value reached 0.99 for the 
      prediction of CSA from the presence of PB. The presence of CSA syndrome, using 
      logistic regression analysis, is associated with a more severe functional status 
      (NYHA: p<0.01, peak VO2: p<0.002), a lower basal and peak end-expiratory CO2 
      pressure (PETCO2, all p<0.03), a worse LVEF (p<0.01) and age equal to or more 
      than 60 years (p<0.03). CONCLUSIONS: The observation of PB in the preliminary 
      period of the CPX test in CHF patients appeared highly predictive of the presence 
      of CSA syndrome during sleep and could prompt the use of polygraphic monitoring 
      in severe CHF patients.
FAU - Roche, Frederic
AU  - Roche F
AD  - Service de Physiologie Clinique et de l'Exercice & Association de Recherche 
      Synapse, CHU Nord, Niveau 6, Faculte de Medecine Jacques Lisfranc, Universite 
      Jean Monnet, F-42055 Saint-Etienne Cedex 2, France. 
      Frederic.Roche@univ-st-etienne.fr
FAU - Maudoux, Delphine
AU  - Maudoux D
FAU - Jamon, Yann
AU  - Jamon Y
FAU - Barthelemy, Jean-Claude
AU  - Barthelemy JC
LA  - eng
PT  - Journal Article
DEP - 20070829
PL  - Netherlands
TA  - Sleep Med
JT  - Sleep medicine
JID - 100898759
RN  - 142M471B3J (Carbon Dioxide)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Aged
MH  - Carbon Dioxide/blood
MH  - Cheyne-Stokes Respiration/*diagnosis/etiology
MH  - *Exercise Test
MH  - Female
MH  - Heart Failure/complications/*diagnosis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Monitoring, Ambulatory
MH  - Oxygen/blood
MH  - *Polysomnography
MH  - Prospective Studies
MH  - Sensitivity and Specificity
MH  - Sleep Apnea, Central/*diagnosis/etiology
EDAT- 2007/09/01 09:00
MHDA- 2008/12/17 09:00
CRDT- 2007/09/01 09:00
PHST- 2006/10/02 00:00 [received]
PHST- 2007/03/19 00:00 [revised]
PHST- 2007/06/26 00:00 [accepted]
PHST- 2007/09/01 09:00 [pubmed]
PHST- 2008/12/17 09:00 [medline]
PHST- 2007/09/01 09:00 [entrez]
AID - S1389-9457(07)00251-1 [pii]
AID - 10.1016/j.sleep.2007.06.012 [doi]
PST - ppublish
SO  - Sleep Med. 2008 May;9(4):411-7. doi: 10.1016/j.sleep.2007.06.012. Epub 2007 Aug 
      29.