Positive association between Cheyne-Stokes respiration events and diastolic dysfunction in pre-heart failure: a cross-sectional study with longitudinal implications.

Background: Cheyne-Stokes respiration (CSR), a distinct type of sleep-related breathing disorder, is closely associated with heart failure (HF). In clinical practice, it has been observed that some patients with CSR do not present with HF or related symptoms. However, limited studies have investigated this phenomenon. This study aimed to explore whether CSR events may indicate specific cardiac structural/functional alterations or serve as an early warning sign for HF progression. Materials and methods: We enrolled middle-aged and elderly patients (≥45 years) hospitalized at Guangdong Provincial Hospital of Traditional Chinese Medicine without a diagnosis or symptoms of HF. Data on medical history, echocardiography, BNP/NT-proBNP levels, and polysomnography were collected. Participants were categorized into three groups based on PSG results: (1) Sleep-Related breathing disorders with CSR, (2) Sleep-Related breathing disorders without CSR, and (3) no Sleep-Related breathing disorders. Comparative analyses of clinical parameters were performed across groups. Results: A total of 171 patients were included. Patients with CSR events exhibited significantly higher BNP/Nt-proBNP levels and more pronounced cardiac structural remodeling, including left atrial enlargement and elevated E/e' ratios. Further analysis identified CSR events as independent risk factors for elevated BNP/Nt-proBNP levels [OR = 2.02, 95%CI (1.02-3.98), p = 0.044], left atrial diameter index [OR = 3.15, 95%CI (1.50-6.64), p = 0.002], and E/e' ratio [OR = 15.32, 95%CI (6.48-36.22), p < 0.001]. Conclusion: In patients without overt HF, the presence of CSR events is positively correlated with left ventricular diastolic dysfunction. CSR events may serve as a biomarker for persistent cardiac diastolic impairment or an early indicator of pathological progression toward heart failure with preserved ejection fraction (HFpEF). These findings warrant further longitudinal investigations to validate its predictive value in clinical settings.