1245 Cheyne-Stokes Respiration and Circulation Time—A Case to Add to the Mystery

• Published in: Sleep (New York, N.Y.) N.Y.), 2020-05, Vol.43 (Supplement_1), p.A474-A475
• Main Authors: Bhura, Sajeer, Rupani, Nawaz, Massoud, Mona, Chowdhuri, Susmita, Shamim-Uzzaman, Q Afifa
• Format: Article
• Language: English
• Subjects: Heart failure; Respiration
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsaa056.1239

Abstract Introduction Lung-to-finger circulation time (LFCT), the time taken for the circulation to reach the fingertips from the lungs, has been shown to correlate inversely with cardiac function (Hosokawa et al. 2015). LFCT can be measured on PSG as the time from the start of rebreathing after a central respiratory event to the nadir of the oxygen desaturation on the SpO2 signal. Patients with congestive heart failure (CHF) have been found to have increased LFCT, with even longer LFCT in patients with Cheyne-Stokes Respirations (CSR). We are reporting a case where LFCT increased throughout a single night by more than 40%. Report of Case A 66-year-old diabetic male with ischemic cardiomyopathy (LVEF 25%), CVA with residual L-sided paresthesias, CKD-IV and hypertension was diagnosed with severe CSA and OSA (AHI 31.5, CAI 13.9, OAI 0.0, MAI 0.2, hypopnea index of 17.4, minimum SpO2 of 80%; supine AHI 56.1). CSR was not mentioned on this diagnostic study. On his titration study, CPAP and BPAP failed to treat CSA, but ASV effectively treated his sleep-disordered breathing; however, he could not be started on ASV due to HFrEF. On a repeat titration after ICD implantation, CSR was prominent in the supine position, on both CPAP and BPAP S/T therapy. Cycle length progressively increased from 40 seconds at the beginning to 57 seconds at the end of the recording, an increase of 42% throughout the night. Circulation time also increased from 31 seconds to over 40 seconds. Scorable central respiratory events resolved but periodicity persisted. Conclusion To our knowledge, this is the first case of CSR with such progressive prolongation in cycle length during a single night. It again raises the question of the role of BPAP S/T in CSR with heart failure, and clarification of the potential use of supplemental oxygen in such situations.