Author + information
- Warren G. Guntheroth, MD⁎ ()
- ↵⁎Department of Pediatrics (Cardiology), University of Washington, Box 356320, Seattle, Washington 98195-6320
Giannoni et al. (1) report that “dynamic CO2 administration, delivered at an appropriate time during periodic breathing, can almost eliminate oscillations in end-tidal CO2 and ventilation.” This was based on 7 volunteers and 7 patients in heart failure with “dynamic pre-emptive CO2 ventilation.” They assert that oscillations in end-tidal carbon dioxide (CO2) drive the ventilatory oscillations in periodic breathing in heart failure, but they offer no proof. Although end-tidal CO2 will oscillate with periodic respiration, so does oxygen, and a strong case might be made that hypoxic drive causes periodic breathing.
More than 1 century ago, Douglas and Haldane (2) showed that, relative to treatment, “pathological Cheyne-Stokes breathing is abolished by the administration of either oxygen or air containing excess of CO2.” But the first priority for heart failure with periodic breathing should be focused on the failure, although continuous positive airway pressure improves both ventricular function and periodic breathing (3). It makes little sense to treat such a patient with CO2; oxygen is more focused and better-tolerated by patients.
For a patient with only central sleep apnea, mandibular advancement with a dental device is simple, better-tolerated, and much less expensive than a dedicated computer with sensors for CO2.
- American College of Cardiology Foundation