Elsevier

Sleep Medicine Clinics

Volume 2, Issue 4, December 2007, Pages 615-621
Sleep Medicine Clinics

Prevalence and Impact of Central Sleep Apnea in Heart Failure

https://doi.org/10.1016/j.jsmc.2007.08.001Get rights and content

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 beta-blockers. Furthermore, it has been shown that central sleep apnea may contribute to mortality of heart failure patients. However, the impact of therapy for sleep apnea on survival of heart failure patients needs to be further determined.

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.

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