Persistence of Cheyne-Stokes breathing after left ventricular assist device implantation in patients with acutely decompensated end-stage heart failure.

Three patients, who were admitted for acute decompensation of end-stage congestive heart failure (CHF), underwent nocturnal polysomnography (PSG) before, and from 7 to 80 days after, left ventricular assist device (LVAD) implantation. Moderate to severe sleep-disordered breathing (SDB) was diagnosed in all 3 patients within 48 hours of admission, consisting predominantly of Cheyne-Stokes breathing (CSB) with central sleep apnea. After LVAD implantation, despite improved hemodynamics and end-organ function, the patients continued to have moderate or severe CSB, although there was decreased time in CSB in 2 of them. These data suggest that optimization of hemodynamics and end-organ function with LVAD implantation in patients with acutely decompensated heart failure does not acutely reverse the central mechanisms underlying the diathesis for this CSB in this setting, nor does it protect patients from the potential morbidity associated with such SDB when CSB and decompensated heart failure co-exist.