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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

View larger version (16K): [in a new window]   Figure 1 Percentage of time spent in the left lateral decubitus (LLD) and right lateral decubitus (RLD) positions among patients with congestive heart failure (CHF) and controls. Patients with CHF spent a significantly smaller percentage of sleep period time in the LLD position than the RLD position; 2.5% (0, 23.7) versus 22.8% (0, 52.7), respectively. No significant difference was observed among controls. Data are nonnormally distributed as indicated by box plots. Error bars = the 10th and 90th percentiles; horizontal lines = the median; rectangular boxes = 25th and 75th percentiles. *p < 0.05.

View larger version (17K): [in a new window]   Figure 2 Comparison of the percentage of time spent in the left lateral decubitus (LLD), right lateral decubitus (RLD), and supine positions compared between patients with congestive heart failure divided dichotomously into those above and below the median values for left ventricular end-diastolic diameter (LVEDD) (62.5 mm), pulmonary capillary wedge pressure (PCWP) (11.5 mm Hg), and cardiac output (CO) (4.7 l/min). Mean (± SD) values above and below these medians were: LVEDD, 72.5 ± 6.5 vs. 57.2 ± 3.8 mm; PCWP, 19.8 ± 6 vs. 6.8 ± 3.1 mm Hg; and CO, 5.7 ± 0.8 vs. 3.8 ± 0.7 l/min. Patients with larger LVEDD, higher PCWP, and lower CO spent less time in the LLD position. No significant differences were found in time spent in the RLD or supine positions based on these dichotomous divisions. Data are nonnormally distributed (see Fig. 2.) *p < 0.05.