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CLINICAL STUDY: HEART FAILURE

Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function

Richard S. T. Leung, MD^*, Michael E. Bowman, BSc^*, John D. Parker, MD, Gary E. Newton, MD and T. Douglas Bradley, MD^*,*

^* Sleep Research Laboratory of the Toronto Rehabilitation Institute , Toronto, Ontario, Canada
Harrowston Heart Failure Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada
Centre for Sleep and Circadian Biology, Department of Medicine, Toronto General Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada

Manuscript received April 24, 2002; revised manuscript received September 10, 2002, accepted September 20, 2002.

^* 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.
douglas.bradley{at}utoronto.ca

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.

Abbreviations and Acronyms   AHI   apnea-hypopnea index   BMI   body mass index   CHF   congestive heart failure   CO   cardiac output   HR   heart rate   LLD   left lateral decubitus   LVEDD   left ventricular end-diastolic diameter   PCWP   pulmonary capillary wedge pressure   RLD   right lateral decubitus   SaO2   oxyhemoglobin saturation

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