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Objectives: We evaluated retrospectively the daily target coverage using cone-beam computed tomography (CBCT) in breath-hold image-guided radiotherapy (BH-IGRT) for gastric lymphoma. Methods: BH-IGRT was performed using a prescribed dose of 30.6 Gy in 17 fractions for the whole stomach. We assessed the target coverage of the whole stomach on daily CBCT images [daily clinical target volume (CTV)], which was delineated individually by two observers. We evaluated V95% (percentage of volume receiving ≥95% of the prescribed dose) of daily CTV. Results: In total, 102 fractions from 6 patients were assessed. The mean V95% of daily CTV was 97.2%, which was over 95%. In two of six patients, the V95% of daily CTV was over 95% for either observer in all fractions. One patient had significant interobserver variation (p = 0.013). In 95 fractions (93%), the V95% of daily CTV was over 95% for either observer. Conclusion: Daily target coverage for CTV in BH-IGRT for gastric lymphoma seems to be favorable, even when using CBCT. Advances in knowledge: A previous study ascertained good daily target coverage in BH-IGRT for gastric lymphoma using in-room CT. Even when using CBCT in our study, daily target coverage for CTV in BH-IGRT for gastric lymphoma seems to be favorable.

Purpose The aim of this study was to investigate the impact of pelvic rotational setup error on lymph nodal dose in the whole pelvic intensity-modulated radiation therapy using the fiducial marker. Methods The dose differences of clinical target volume for pelvic lymph node (CTVLN) due to isocenter (IC) shift and pelvic rotation were evaluated using the radiation treatment planning system. The rotated computed tomography (CT) images were created for the simulation of the pelvic rotation. The original CT images were rotated around the IC of the original plan in the pitch and roll directions up to±3.0 deg. at 1.0 deg. intervals. As simulated plans, IC positions were shifted in the anterior-posterior and superior-inferior directions up to±10 mm at 2 mm intervals in the original and rotated CT images, and the dose distributions were calculated. The dose calculation was performed for each CT image while keeping the movement of multi leaf collimator and the monitor unit of the original plan. The differences between D98% of CTVLN in the original plan and simulated plans were calculated. Results In the posterior direction shifts of 4, 6, 8, and 10 mm, the dose reduction of 0.7, 2.1, 6.1, and 11.9% from the original plan were found for D98% of CTVLN, respectively. The dose reductions due to the rotation of pitch direction were greater than the rotation of roll direction. In the posterior direction shifts of 4, 6, 8, and 10 mm with 3.0 deg. rotation of pitch direction, the dose reduction of 2.2, 6.8, 12.8, and 19.0% from the original plan were found, respectively. Conclusion The dose reduction of CTVLN might be occurred due to the rotational setup error of pitch direction.

The Diesel Particulate NOx Reduction system (DPNR), the latest system in Toyota’s D-CAT concept, combines a new catalyst and the Low Temperature Combustion (LTC) process to simultaneously reduce particulate matter (PM) and NOx emissions from diesel vehicles.

The pharmacokinetics of pirmenol hydrochloride (pirmenol), a new antiarrhythmic agent, and its suppressive effects on ventricular premature contractions (VPC) were studied in 16 patients following single oral administration of 75mg, 100mg, and 150mg of the drug. In 8 of 16 patients, suppressive effects on VPC were also studied following multiple oral administration of pirmenol of 75mg b. i. d. or 100mg b. i. d. Blood samples were drawn before and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 24 and 48hr after single oral administration. In the multiple oral administration study, blood samples were collected before and 2hr after morning dose during the treatment period. Plasma and urine drug concentration were measured using high performance liquid chromatography (HPLC). Plasma protein binding of pirmenol was determined by an ultrafiltration method. A 48-hr continuous ECG and standard 12-lead ECGs were recorded to assess the effects of pirmenol on VPC and ECG parameters.The Cmax and AUC after single administration were 0.799μg/ml & 9.23μg·hr/ml in 75mg group (n=6), 0.784μg/ml & 11.23μg·hr/ml in 100mg group (n=6) and 1.156μg/ml & 15.70μg·hr/ml in 150mg group (n=4), respectively. The Cmax and AUC increased in a dose-dependent manner. The Tmax, t1/2 β, urinary excretion rate and protein binding rate were independent of the dosage. The Cmax and Cmin at the steady state during multiple administration were 1.149 & 0.235μg/ml in 75mg b. i. d. group (n=2) and 1.472 & 0.598μg/ml in 100mg b. i, d, group (n=6). Suppressive effects of pirmenol on VPC were observed in 5 out of 12 patients with more than 3, 000VPC/day in the single administration study and also in 3 out of 4 patients in the multiple administration study. The minimum effective plasma concentration of pirmenol was 0.361±0.133μg/ml. The PQ & QT interval and QTc were prolonged significantly after single and multiple administration. Serious adverse events were not observed in any patients during the study.We conclude that pirmenol is a useful antiarrhythmic agent for the treatment on VPC, and that 100mg b. i, d, is safe and suitable for chronic management of the patients with frequent VPC.

In order to investigate the antianginal effects of celiprolol (NBP-582), a randomized double-blind crossover study controlled with placebo was carried out in 17 patients with stable effort angina pectoris. Multistage treadmill exercise testing was performed before and at 4, 7, and 24 hr after a single oral administration of 400mg celiprolol or placebo. The exercise testing was terminated at moderate angina pain.The treadmill exercise duration showed no statistically significant time effects or order effects either before or after administration of the test drugs.Celiprolol significantly prolonged exercise duration, time to angina, and time to onset of ST-segment depression≥0.1mV at 4, 7, and 24hr after administrationin comparison with placebo. However, there was no significant difference in time to angina disappear ance at 4, 7, and 24 hr after administration between celiprolol and placebo.Celiprolol significantly reduced systolic blood pressure at rest in a standing position and peak exercise, and peak exercise at 4 and 7hr after administration respectively in comparison with placebo. At 24hr after administration, tendency of reduction of systolic blood pressure was observed at peak exercise.There was no significant difference in diastolic blood pressure at 4, 7, and 24hr after administration between celiprolol and placebo. Celiprolol significantly reduced heart rate and pressure rate product (PRP) at peak exercise at 4, 7, and 24hr after administration in comparison with placebo.No significant difference in ST deviation was observed at peak exercise at 4, 7, and 24hr after administration between celiprolol and placebo. A tendentious or significant prolongation of alleviated exercise-induced ST depression (ST SXT) was observed at 4hr or at 7and 24hr after administration.Celiprolol significantly reduced heart rate, PRP, and ST deviation during exercise over 24hr.These results indicate that celiprolol significantly increases exercise tolerance in patients with stable effort angina pectoris over 24hr after a single oral administration of 400mg. It is concluded that celiprolol is a clinically useful antianginal agent.

健常成人 (NL) 20名および冠動脈疾患 (CAD) 患者52名を対象とした。多段階臥位自転車ergometer運動 (MBEX) に対するR波高変化を解析し, CADの診断あるいは重症度判定におけるその有用性について検討した。NL群とCAD群においてR波高は運動につれて減少し, 最大運動時に最も小さくなった。R波増高または不変を陽性とするBonorisらのR波高診断基準を用いたCAD診断の感度は21%であるが, ST基準による感度は65%であり, R波高基準はST基準に比し有意に低感度であった (p

NT-1 is a transdermal tape containing 5 mg nitroglycerin and is expected to havesustained efficacy of nitroglycerin.In order to compare the antianginal effects of 5mg NT-1 and 10 mg NT-1 on exercisetolerance, a ramdomised double-blind cross-over study was carried out in 19 patientswith stable effort angina pectoris. Multistage treadmill exercise testing was performedin all patients before and at 2 hours after a single topical application of 5 mg NT-1 or 10mg NT-1. It was also performed in 12 out of the 19 patients, as a open study, before andat 2 hours after a single topical application of a placebo tape. The exercise testing wasterminated at moderate anginal pain.Before topical application, there were no significant differences in treadmill exerciseduration, heart rate, systolic blood pressure, or ST deviation between 5 mg NT-1 or 10mg NT-1. At 2 hours after the application, systolic blood pressure at rest was morereduced with 10 mg NT-1 than with 5 mg NT-1. However, there were no significantdifferences in treadmill exercise duration, heart rate, systolic blood pressure at peakexercise, or ST deviation between 5 mg NT-1 and 10 mg NT-1. At 2 hours after a singletopical application of NT-1, the mean plasma level of nitroglycerin was twice as highwith 10 mg NT-1 as with 5 mg NT-1.In all 12 patients who were subjected to the placebo open study, treadmill exerciseduration was significantly longer with NT-1 than with placebo, irrespective of dosagestudied. However, there were no significant differences in systolic blood pressure, pressure-rate product, or ST deviation at peak exercise between NT-1 and placebo.These results indicate that the topical application of NT-1 significantly increasesexercise tolerance in patients with stable effort angina pectoris, and that the antianginaleffects of 5 mg NT-1 are approximately equal to those of 10 mg NT-1.

In order to investigate the effect of isosorbide 5mononitrate (5-ISMN) on exercise tolerance, a controlled study was carried out in 11 patients with effort angina pectoris. Multistage treadmill exercise testing was performed before, and 2, 4, and 7 hours after a single oral dose of placebo at 9: 30 to 10 o'clock in the morning. Two to seven days later, the test was again performed with the test drug (TY-10368) containing 20 mg of 5-ISMN according to the identical test protocol. It was terminated at moderate anginal pain.Before administration, there were no significant differences in treadmill exercise duration, pressure-rate product (PRP), and ST deviation between TY-10368 and placebo.At 2, 4, and 7 hours after the administration, the exercise duration was significantly longer after TY-10368 than after placebo (P

Retinal artery embolism that had arisen as a complication of a left atrial myxoma was diagnosed in a young man who had suddenly developed a visual disorder in his left eye. A tumor in the left atrium was surgically excised. Pathologically, retinal embolism secondary to atrial myxoma is rare. To our knowledge, only 15 cases have been documented so far. The present case was only the second case of an isolated retinal embolism that had developed without systemic involvement, and the first case of retinal artery branch embolism that had resulted from a left atrial myxoma.

To investigate hemodynamic effects of a new coronary vasodilator, 2-nicotinami doethyl nitrate (nicorandil), 12 patients with prior myocardial infarction were stu died. Patients with angina pectoris were excluded.Hemodynamic measurements were made during supine bicycle ergometer exercise testings before and 60 min after single oral administration of 15 mg of nicorandil. Symptom-limited exercise testing was performed before nicorandil, and after nicoran dil the same workload was assigned to each patient. At peak exercise, there was a significant increase in cardiac index, while stroke volume index remained unchanged after nicorandil. Both at rest and at peak exercise, there was a significant decrease in systolic and diastolic blood pressure, systemic vascular resistance, and pulmonary capillary wedge pressure after nicorandil. Coronary sinus blood flow was significant ly increased and coronary vascular resistance was significantly decreased after nicor andil both at rest and peak exercise. The average value for plasma nicorandil concen tration was 215ng/ml 60min after dosing.These data would indicate that nicorandil exhibits a beneficial effect on hemodyna mic responses to exercise in patients with prior mycoardial infarction by reduction of left ventricular preload and afterload and by increment in coronary blood flow.

In order to investigate the antianginal effects of a new calcium antagonist, nilvadipine, a randomized double-blind cross-over study controlled with placebo wascarried out in 15 patients with stable effort angina pectoris. Multistage treadmillexercise testing was performed before, and at 2, 4, and 7 hours after a single oraladministration of 6 mg nilvadipine or placebo. The exercise testing was terminated atmoderate anginal pain.The treadmill exercise duration showed no statistically significant time effects ororder effects either before or after administration of the test drugs. Before administration, there were no significant differences in exercise duration, time to onset of STsegment depression≥0.1 mV, pressure-rate products, or ST deviation between nilvadipine and placebo.Nilvadipine significantly prolonged exercise duration at 2, 4, and 7 hours after dosing, and time to onset of ST-segment depression≥0.1 mV at 2 and 4 hours after dosing.However, there were no significant differences in ST deviation at peak exercise betweennilvadipine and placebo.Nilvadipine significantly reduced resting systolic blood pressure at 2 and 4 hoursafter dosing. At peak exercise, nilvadipine significantly increased heart rate at 2 and 7hours, and pressure-rate product at 2 hours after dosing, respectively.These results indicate that nilvadipine significantly increases exercise tolerance inpatients with stable effort angina pectoris up to 7 hours after a single oral administrationof 6 mg. It is concluded that nilvadipine is a clinically useful antianginal agent.

To investigate the hemodynamic effects of isosorbide-5-mononitrate (ISMN), 11 patients with effort angina pectoris were studied.Hemodynamic and echocardiographic measurements were observed at rest and during angina-limited supine multi-stage bicycle ergometer exercise testings before and 120 min after oral administration of 20 mg of ISMN. Compared with the control exercise test, the mean ST-segment at peak exercise showed less depression after ISMN (P

A placebo-controlled study was performed in 13 patients with stable effort angina pectoris in order to evaluate the effect of TTS-NTG on exercise tolerance. Multistage treadmill exercise testing was performed according to the modified Bruce protocol before and 2, 7, and 24 hours after a single topical application of a placebo identical in appearance to the active TTS-NTG at 9: 30 to 10: 00 am. One or 2 days later, the exercise testing was repeated on active TTS-NTG at 25mg/10 cm2 or 50mg/20cm2.1) In the pre-treatment period, there were no significant differences in exercise duration, pressure-rate product (PRP), or ST deviation between TTS-NTG placebo/10cm2 and TTS-NTG 25mg/10cm2. There was no significant difference in exercise duration between placebo/20cm2 and TTS-NTG 50mg/20cm2, but at the exercise endpoint, TTS-NTG 50mg/20cm2 increased PRP and tended to increase ST deviations.2) Both TTS-NTG 25mg/10cm 2 and 50mg/20cm2 significantly prolonged or tended to prolong exercise duration at 2, 7, and 24 hours after topical application as compared with the control (data from the placebo study of corresponding duration).3) In comparison with the control, PRP at the endpoint significantly increased or tended to increase with TTS-NTG 50mg/20cm2, but showed no constant tendency with TTS-NTG 25mg/10cm2.4) Active TTS-NTG showed no significant changes in ST deviation at the endpoint as compared with the control.5) The mean plasma nitroglycerin concentration was maintained within the ranges of 0.29 to 0.34ng/ml and 0.30 to 0.41ng/ml during the interval of 2 to 24 hours after a single application of TTS-NTG 25mg/10cm2 and 50mg/20cm2, respec tively. In one patient in whom the exercise testing was also conducted with TTSNTG 50mg/20cm2, the plasma concentration reached a higher level and the exercise duration was much more prolonged as compared with TTS-NTG 25mg/10cm 2.In conclusion, it was demonstrated that TTS-NTG maintained a constant plasma concentration of nitroglycerin through 24 hours after a single application and improved the exercise tolerance in patients with stable effort angina pectoris. Thus, it is concluded that TTS-NTG is a useful long-acting antianginal agent.

To investigate the antianginal effects of nisoldipine, a placebo-controlled study was performed using 10 patients with stable angina pectoris on effort. Anginal symptom-limited treadmill exercise tests were performed before and 2, 4, 7, and 24 hours after a single oral dose of placebo at 10: 00 am. A few days later, the exercise test was again performed before and after the administration of 10 mg of nisoldipine according to the same schedule followed in the placebo trial.Between tests before placebo and nisoldipine administration, there were no significant differences in exercise time, pressure- rate product (PRP), or ST deviation at peak exercise.Compared with the placebo trials, the exercise time was significantly prolonged after nisoldipine administration and its increments were 100.1, 74.5, 85.0, and 43.6 sec at 2, 4, 7, and 24 hours after administration, respectively. The plasma concentration of nisoldipine and the increment of exercise time reached maxima at 2 hours after nisoldipine administration. Two hours after administration, the peak PRP was significantly greater after nisoldipine administration than after placebo and before nisoldipine administration. The ST deviation at peak exercise was not significanty different between the placebo and nisoldipine trials.This indicates that nisoldipine exerts an antianginal effect for more than 24 hours. It is considered to be a clinicaly useful agent in the management of angina pectoris on effort.

A multicenter, double-blind study was performed in 46 patients with stable effort angina pectoris on maintenance doses of long-acting nitrate in order to evaluate the effect of levocarnitine chloride (LC-80) tablets, containing 200 mg of levocarnitine chloride, on exercise tolerance. Multistage treadmill exercise testing was performed according to the modified Bruce protocol at the pre-treatment period and after 4 and 8 wk of oral daily doses of 1800 mg of LC-80 or placebo therapy.In the pre-treatment period, there were no significant differences in treadmill exercise duration, time to the onset of angina, pressure-rate product (PRP), and ST deviation between the placebo and LC-80 groups.The time to the onset of angina was significantly longer after 4 (P

Cibenzoline is a newly developed antiarrhythmic drug which possesses a local anesthetic action. We studied the pharmacokinetics of cibenzoline and its effects on ventricular premature contractions (VPCs) in 27 patients by a single oral administration method.Blood samples were drawn before and at 0. 5, 1, 2, 3, 4, 6, 8, 12, 24, 36, and 48 hr after the drug administration (4 mg/kg) to measure the plasma drug concentration using high performance liquid chromatography (HPLC). A standard 12-lead ECG was recorded at the time of blood sampling to evaluate the effects of cibenzoline on electrocardiographic parameters and a 24-hr dynamic ECG was also obtained on the day before and after the drug administration to assess the suppressive effects on VPCs. Tmax. was 2.9±1.5 hr in 23 patients with normal renal function (group A) and 3. 1±1. 5 hr in 4 with renal dysfunc tion (group B). Cmax was 596±228 ng/ml for group A and 739±134 ng/ml for group B. T1/2β was 10. 1±5.1 hr for group A and 13. 5±1. 8 hr for group B, and AUC was 5, 880± 2, 334ng/ml·hr for group A and 11, 864±5, 165ng/ml·hr for group B. Urinary excretion rate was 43±16% for group A and 31±20% for group B. Effective suppression of VPCs was found in 17 out of 20 patients who had VPCs of more than 1, 000/24 hr. The average of the minimum effective plasma concentration that was defined as the one showing more than 75% reduction of the baseline frequency of VPCs (beats/hr) was 329±147 ng/ml. RR, PQ and QTc intervals, and QRS duration were prolonged, and blood pressure was slightly elevated after the drug administration. However, there were no serious adverse effects in any patient. These data suggest that 1) pharmacokinetics of cibenzoline strongly depends on the renal function of individual patients, 2) cibenzoline was a safe and highly effective antiarrhythmic drug on VPCs, 3) the drug concentration should be monitored during the maintenance therapy in patients with renal dysfunction.

In order to investigate the effects of nipradilol on exercise tolerance, a placebocontrolled study was carried out in 12 patients with stable effort angina pectoris . Multistage treadmill exercise testing was performed before, and at 2, 4, and 7 hours after a single oral administration of placebo at 9: 30 to 10: 00 am . Two to seven days later, the exercise test was again performed with a single oral dose of 6mg nipradilol according to the identical test protocol. In 7 out of 12 patients, treadmill exercise testing was further performed before and 2 hours after a single oral dose of 40mg propranolol. The exercise testing was terminated at moderate anginal pain.Before administration, there were no significant differences in treadmill exercise duration, heart rate, systolic blood pressure or ST deviation between nipradilol and placebo. At 2, 4, and 7 hours after the administration, the exercise duration was significantly longer after nipradilol than after placebo. However, there were no significant differences in ST deviation at peak exercise between nipradilol and placebo.Heart rate and systolic blood pressure at rest and systolic blood pressure at peak exercise were significantly reduced or tended to be reduced after nipradilol when compared with placebo.In 7 patients, there were no significant differences in treadmill exercise duration, heart rate, systolic blood pressure, or ST deviation between nipradilol and propranolol.These results indicate that nipradilol significantly increases erercise tolerance in patients with stable effort angina pectoris even at 7 hours after a single oral administration mainly due to the decrease in myocardial oxygen demand by beta-blocking action.

心予備能の非観血的評価法の妥当性を,観血的評価法と対比し検討した.冠動脈疾患患者55例,健常人8例を対象として多段階臥位自転老エルゴメータ運動試験を施行し,肺動脈楔入圧(PCWP),心係数(CI),心エコー図による左房径(LAD)を経時的に測定した.各計測値は運動極期と安静時の値の差(δ)として示した.観血的心予備能分類としてδPCWP=8mmHg,δCI=2.5l/min/m2を臨界値として対象を4群に分類した.δPCWPとδLAD3の間にはr=0.74 (p

Hemodynamic effects of isosorbide-5-mononitrate (ISMN) were studied in 14 patients with effort angina pectoris. Hemodynamic and echocardiographic data were obtained by angina-limited supine multistage bicycle ergometer exercise testing before and 120 minutes after single oral administration of 20 mg of ISMN. Compared with control exercise testing, the ST segment at peak exercise showed less depression after administration of ISMN (p less than 0.001). At rest, systolic and diastolic blood pressure decreased significantly after administration of ISMN (p less than 0.001 and p less than 0.01, respectively). At rest and at peak exercise, pulmonary artery wedge pressure (both p less than 0.001), left atrial volume (both p less than 0.001) and left ventricular end-diastolic volume (both p less than 0.05) decreased, whereas cardiac index, pressure-rate product and systemic vascular resistance did not change significantly after administration of ISMN. Average time to peak plasma ISMN concentration was 90 minutes and average peak plasma concentration was 460 ng/ml with an elimination half-life of 7 hours. These data suggest that the main mechanism of the antianginal action of ISMN is a reduction in left ventricular preload followed by diminution of myocardial oxygen requirements.

心房細動 (AF) および期外収縮は加齢とともに有意に増加する. 過去10年間, 人間ドック検査を受けた約24万人の12誘導心電図の検討ではAF頻度は70歳以上の高齢者においては (男性2.5%, 女性0.3%) 若年者に比し有意に高かった. 老年科診療においてはAFはより高頻度にみられ, その治療は日常診療で大きな比重を占める. 高齢AF患者の3大基礎疾患は弁膜症, 高血圧性および虚血性心疾患であり, 10%は孤立性AFであった.AFでは統一ある心房収縮はなく, 心室充満および1回拍出量は主に急速充満に依存し, 後者はRR間隔および流入抵抗により規定される. Pulse Doppler 法による研究では個々の患者では左室流入量および直続心拍の1回拍出量はRR間隔のみに依存するように思われ, RR間隔が個々の患者に固有の閾値より長い場合にはほぼ一定の値を示したが, R-R間隔が閾値以下となればその短縮に伴って直線的に減少した. R-R間隔閾値は左室流入抵抗に依存し, 僧帽弁狭窄症, 左室 compliance 低下症例では延長する. Pulse Doppler 法による検討では健常男性でも左室 compliance は加齢とともに低下することが示され, AFは, 有意な心疾患のない場合でも高齢者により大きな心血行力学的負担を課すると考えられる.発作性AF患者の treadmill 試験ではAFは洞調律に比し著しく強い心拍数反応を示し, この過剰心拍数反応がAFでみられた運動時間短縮の原因と考えられた. Digitalis は運動に対する心拍数過剰反応を軽減し, 運動耐容能を有意に改善したが, 多くのAF患者で運動時心拍数はなお過多と思われた. Digitalis 維持投与下のAF患者に verapamil 80mgまたは diltiazem 60～90mgを1回経口投与後には運動時心拍数はさらに抑制され treadmill 運動時間は有意に延長した. しかしβ遮断薬は心拍数の高度抑制にもかかわらず有意な運動耐容能の改善を示めさなかった. Digitalis とこれらのCa拮抗薬との併用はAFの運動時心拍数コントロールに有効な治療と考えられた.頭部CT検査を受けた急性脳血管障害患者432名の検討ではAFの頻度は, 脳出血に比し脳梗塞では有意に高かった (18.8% vs 2%). 脳血管写を受けた急性脳血管障害患者72名では, AF頻度は脳出血患者37名で2.7%, 脳血栓患者29名で20.7%, 脳塞栓患者5名で80%であり, 前2者に比し後者では有意に高かった. 脳血管写で確認した脳塞栓患者102名では73名がAFを示し, うち23名は孤立性AFであった. これらの所見は, 脳梗塞がAFの存在と密接に関連していることを示し, 孤立性AFも塞栓症の原因となりうることを示唆する. 脳塞栓の危険性の高い患者の同定およびその防止はAF患者の管理における緊急課題である.

Polysomnography was carried out in 11 adult outpatients with stable chronic heart failure (CHF) due to valvular heart disease in order to investigate respiratory abnormalities during sleep. The subjects consisted of 6 males and 5 females and their ages ranged from 54 to 76 years. A coexisting central dominant sleep apnea syndrome (SAS) was found in 4 males, 3 of whom had evidence of nasal obstruction. A successful mitral valve replacement in one patient with central dominant SAS was associated with a reduction in the frequency of sleep apnea. The results suggest complications caused by respiratory abnormalities during sleep are common and should be considered in the management of patients with CHF.