Is dynamic desaturation better than a static index to quantify the mortality risk in heart failure patients with Cheyne-Stokes respiration?

• Published in: Chaos (Woodbury, N.Y.) N.Y.), 2018-10, Vol.28 (10), p.106312-106312
• Main Authors: Granitza, Philine, Kraemer, Jan F., Schoebel, Christoph, Penzel, Thomas, Kurths, Jürgen, Wessel, Niels
• Format: Article
• Language: English
• Subjects: Adult; Aged; Apnea; Body Mass Index; Cheyne-Stokes Respiration - physiopathology; Cohort Studies; Cut-off; Desaturation; Female; Heart; Heart failure; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Male; Medical prognosis; Middle Aged; Mortality; Oxygen - chemistry; Oxygen Consumption; Oxygenation; Patients; Precision Medicine; Prevalence; Respiration; Sleep Apnea Syndromes; Time Factors; Ventricular Function, Left
• ISSN: 1054-1500; 1089-7682
• DOI: 10.1063/1.5039601

Cheyne-Stokes respiration (CSR) is a periodic, highly dynamic, respiratory pattern and a known comorbidity in congestive heart failure (CHF) patients. It is generally seen as an indicator for a negative prognosis, even if no distinction in degree is known or understood. This paper aims to improve on existing attempts by creating a quantification of the behavior of the dynamic desaturation process of oxygen in the blood. We performed this work on a cohort of 11 subjects with CHF, reduced left ventricular ejection fraction, and CSR. The dynamic desaturation process was evaluated according to changes to peripheral capillary oxygenation S p O 2 resulting from highly nonlinear relationships in the ventilatory system perturbed by periodic breathing. Hypoxaemic burden expressed as a static index T 90 was compared to a novel relative desaturation index R D I, developed in this paper. While T 90 represents a single value calculated using a static cut-off value of 90 % S p O 2, the R D I is more sensitive to dynamic influences as it uses the specific maximum change in saturation for each CSR episode. The threshold of T 90 = 22 min per night as suggested by Oldenburg et al. could not be confirmed to predict survival, but all central apneas resulting in a relative desaturation of S p O 2 above a cut-off value of 8 % were a 100 % positive predictor of mortality. The R D I proved sufficiently stable in intraindividual measurements across CSR epochs. Across the cohort, it showed a bimodal distribution for the deceased group, indicative of a possible aetiological difference. Hence, it is our conclusion that a dynamic approach to analyse desaturation of oxygen during Cheyne-Stokes respiration is to be strongly favoured over a static approach to analysis.