Author + information
- Received April 24, 2002
- Revision received September 10, 2002
- Accepted September 20, 2002
- Published online January 15, 2003.
- Richard S.T Leung, MD*,‡,
- Michael E Bowman, BSc*,
- John D Parker, MD†,
- Gary E Newton, MD† and
- T.Douglas Bradley, MD*,‡,* ()
- ↵*Reprint requests and correspondence:
Dr. T. Douglas Bradley, NU 9-112, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
Objectives We sought to determine whether patients with congestive heart failure (CHF) avoid the left lateral decubitus (LLD) position during sleep and, if so, whether this avoidance would be more pronounced in those with greater degrees of cardiomegaly.
Background Anecdotal reports suggest that, in patients with CHF, the LLD position is associated with discomfort due to the enlarged apical heart beat and greater degree of dyspnea (trepopnea) than other positions. It has also been suggested that the LLD position is associated with increased sympathetic nervous activity.
Methods A total of 75 patients with CHF and 75 control subjects underwent nocturnal polysomnography with monitoring of body position. Echocardiography was performed in all patients with CHF to determine left ventricular end-diastolic diameter (LVEDD). A total of 40 patients underwent cardiac catheterization from which pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were obtained.
Results Patients with CHF spent significantly less time in the LLD position than in the right lateral decubitus position. No such difference was observed among control subjects. Among patients with CHF, those with larger LVEDD, higher PCWP, and lower CO spent less time in the LLD position.
Conclusions Patients with CHF avoid the LLD position spontaneously during sleep. This may be a protective strategy to avoid discomfort from the enlarged apical heart beat or further hemodynamic or autonomic compromise.
☆ Supported by grants MOP-11607 from the Canadian Institutes of Health Research (CIHR) and the Ontario Thoracic Society. Drs. Leung and Bradley are supported by a Clinician Scientist award and a Senior Scientist award, respectively, from the CIHR.
- Received April 24, 2002.
- Revision received September 10, 2002.
- Accepted September 20, 2002.
- American College of Cardiology Foundation