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J Appl Physiol 91: 408-416, 2001;
8750-7587/01 $5.00
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Vol. 91, Issue 1, 408-416, July 2001

Dynamic ventilatory response to CO2 in congestive heart failure patients with and without central sleep apnea

Zbigniew L. Topor1, Linda Johannson2, Jerzy Kasprzyk3, and John E. Remmers2

1 Center for Biomedical Engineering, University of Kentucky, Lexington, Kentucky 40506; 2 Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1; and 3 Institute of Automatic Control, Silesian Technical University, 44-101 Gliwice, Poland

Nonobstructive (i.e., central) sleep apnea is a major cause of sleep-disordered breathing in patients with stable congestive heart failure (CHF). Although central sleep apnea (CSA) is prevalent in this population, occurring in 40-50% of patients, its pathogenesis is poorly understood. Dynamic loop gain and delay of the chemoreflex response to CO2 was measured during wakefulness in CHF patients with and without CSA by use of a pseudorandom binary CO2 stimulus method. Use of a hyperoxic background minimized responses derived from peripheral chemoreceptors. The closed-loop and open-loop gain, estimated from the impulse response, was three times greater in patients with nocturnal CSA (n = 9) than in non-CSA patients (n = 9). Loop dynamics, estimated by the 95% response duration time, did not differ between the two groups of patients. We speculate that an increase in dynamic gain of the central chemoreflex response to CO2 contributes to the genesis of CSA in patients with CHF.

central chemosensitivity; pseudorandom binary stimulation; impulse response; dynamic loop gain; carbon dioxide


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