Postural changes in lung volumes in patients with heart failure and Cheyne-Stokes respiration: Relationship with sleep apnea severity

Background and aim: It has been proposed that the increased severity of sleep apnea frequently observed in heart failure (HF) patients with Cheyne-Stokes respiration (CSR) when sleeping in the supine compared to the lateral position, may be caused by the concomitant reduction in functional residual capacity (FRC). We assessed positional changes in FRC in patients with CSR and investigated the rela-tionship between these changes in the laboratory and corresponding changes in CSR severity during sleep. Methods: After a diagnostic polysomnography, 18 HF patients with dominant CSR and an apnea-hypopnea index (AHI)=15 events/h underwent a standard pulmonary function test in the sitting posi-tion. Measurements were repeated in the supine, left lateral and right lateral. The latter two measure-ments were averaged to obtain a single lateral measurement. Results: The FRC in the seated position was 3.0 +/- 0.5 L (85 +/- 13% of predicted), decreased to 2.3 +/- 0.3 L (-21 +/- 8%, p < 0.0001) in the supine position, and increased to 2.8 +/- 0.4 L (+21 +/- 12%, p < 0.0001) from the supine to the lateral position (-5 +/- 8% vs seated, p = 0.013). During sleep, the AHI and the apnea index (AI) decreased from 47 +/- 15 events/h to 26 +/- 12 events/h (-46 +/- 20%, p < 0.0001) and from 29 +/- 21 events/h to 12 +/- 10 events/h (-61 +/- 40%, p < 0.001) from the supine to the lateral position. Changes in the AI were significantly correlated with corresponding changes in FRC (r =-0.55, p = 0.032). Conclusion: In patients with HF and CSR, lying in the supine position causes a significant reduction in FRC in the context of a chronically reduced FRC. The negative correlation between postural changes in FRC and AI supports the hypothesis that the reduction in lung gas stores in the supine position may promote/ exacerbate respiratory control instability.(c) 2022 Elsevier B.V. All rights reserved.

Automated summary

In patients with heart failure and Cheyne-Stokes respiration (CSR), changes in functional residual capacity (FRC) with different sleep positions were assessed. It was found that lying in the supine position decreased FRC and decreased the severity of CSR during sleep.