Prevalence and Impact of Central Sleep Apnea in Heart Failure
Section snippets
Pathophysiologic consequences of sleep apnea and hypopnea
There are a number of immediate and long-term pathophysiologic consequences of sleep apnea and hypopnea (Fig. 1). Immediate consequences of periodic breathing include hypoxemia and reoxygenation, hypercapnia and hypocapnia, and negative swings of intrathoracic pressure. These changes result in neurohormonal activation, release of inflammatory mediators, increases in transmural cardiac chambers, diminished oxygen delivery, and a host of other adverse effects reviewed elsewhere [35], [36], [37],
Impact of CSA on mortality
CSA may increase the risk of mortality in CHF [14], [15], [16], [17], [18]. Findley and colleagues [15] were the first to report that CSA was associated with increased mortality in patients with systolic heart failure. However, several recent studies have reported conflicting results. A major criticism in most studies is the small number of subjects, either in the CSA or in the control group. In addition, some of the studies combined cardiac transplantation with death as the primary endpoint.
Summary
Sleep apnea is commonly found in patients with systolic heart failure, and recent studies strongly suggest that the prevalence of central sleep apnea remains high, in spite of the use of contemporary treatment of heart failure including β-blockers. Furthermore, it has been shown that CSA may contribute to mortality of heart failure patients. However, the impact of therapy of sleep apnea on survival of heart failure patients needs to be further determined.
References (43)
- et al.
Prognostic value of plasma erythropoietin on mortality in patients with chronic heart failure
J Am Coll Cardiol
(2004) - et al.
Prevalence of sleep-disordered breathing in patients on a heart transplant waiting list
Chest
(1994) - et al.
Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure
J Am Coll Cardiol
(2007) - et al.
Cheyne-Stokes respiration and prognosis in congestive heart failure
Am J Cardiol
(1996) Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report
Int J Cardiol
(2006)- et al.
Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure
Chest
(2005) - et al.
Prevalence and clinical characteristics of sleep apnea in Chinese patients with heart failure
Int J Cardiol
(2007) - et al.
Cost effectiveness of cardiac resynchronization therapy in the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) trial
J Am Coll Cardiol
(2005) - et al.
Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure
J Am Coll Cardiol
(2004) - et al.
Cheyne-Stokes respiration with central sleep apnoea in chronic heart failure: proposals for a diagnostic and therapeutic strategy
Sleep Med Rev
(2006)
Effect of Cheyne-Stokes respiration on muscle sympathetic nerve activity in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
Am J Cardiol
Impact of sleep apnea on sympathetic nervous system activity in heart failure
Chest
ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American college of cardiology/American Heart Association task force on practice guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American college of chest physicians and the international society for heart and lung transplantation: endorsed by the Heart rhythm society
Circulation
Heart failure
N Engl J Med
Prevalence of chronic heart failure in Southwestern Europe: the EPICA study
Eur J Heart Fail
An epidemic of heart failure? Recent evidence from Europe
Eur Heart J
Predictors of mortality and morbidity in patients with chronic heart failure
Eur Heart J
Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure
Eur Heart J
Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000
Eur Heart J
One-year mortality among unselected outpatients with heart failure
Eur Heart J
Systolic dysfunction is a predictor of long term mortality in men but not in women with heart failure
Eur Heart J
Cited by (41)
Evaluation and Treatment of Central Sleep Apnea in Patients with Heart Failure
2022, Current Problems in CardiologyTherapeutic value of treating central sleep apnea by adaptive servo-ventilation in patients with heart failure: A systematic review and meta-analysis
2021, Heart and LungCitation Excerpt :CSA is prevalent among patients with cardiovascular (CV) diseases, especially in those with heart failure (HF).3,4 Similarly to obstructive sleep apnea (OSA), CSA is known to be associated with adverse outcomes in cardiac patients.3 Positive airway pressure (PAP), specifically in the form of adaptive servo-ventilation (ASV), is efficacious in suppressing CSA events and has been reported to improve patients’ ventricular function and quality of life proved by both clinical trials and meta-analyses.5–9
Transvenous phrenic nerve stimulation for central sleep apnea is safe and effective in patients with concomitant cardiac devices
2020, Heart RhythmCitation Excerpt :The prevalence of sleep apnea, both obstructive and central, among patients with heart failure, especially those with heart failure with reduced ejection fraction (EF), is high and approaches 50%–75% in some studies1,2 Untreated central sleep apnea (CSA) is associated with high morbidity and mortality.3,4
Sleep Disordered Breathing and Heart Failure: What Does the Future Hold?
2017, JACC: Heart FailureCitation Excerpt :Prospective data suggest a 2.6-fold increase in the incidence of coronary heart disease and (self-reported) HF after adjustment for age, sex, body mass index, and smoking (7). SDB is common in HF, with prevalence rates of 50% to 75% (8,9) in both HF with reduced ejection fraction (HFrEF) (10) and HF with preserved ejection fraction (HFpEF) (11–13). SDB is also common in acute HF, with reported prevalences of 44% to 97% (14,15).
Cheyne-Stokes respiration: Implications for anaesthesiologists
2017, Anaesthesia Critical Care and Pain Medicine