This article is part of the Topical Collection on Comorbidities of Heart Failure
The majority of patients with heart failure have sleep-disordered breathing (SDB)—with central (rather than obstructive) sleep apnoea becoming the predominant form in those with more severe disease. Cyclical apnoeas and hypopnoeas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalise the sleep and respiratory physiology, but recent randomised trials of cardiovascular outcomes in central sleep apnoea have been neutral or suggested the possibility of harm, likely from increased sudden death. Further randomised outcome studies (with cardiovascular mortality and hospitalisation endpoints) are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnoea, for those with heart failure with preserved ejection fraction, and for those with decompensated heart failure. New therapies for sleep apnoea—such as implantable phrenic nerve stimulators—also require robust assessment. No longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with heart failure and sleep apnoea.
Hillman DR, Murphy AS, Pezzullo L. The economic cost of sleep disorders. Sleep. 2006;29:299–305. PubMed
Levitsky MG. Using the pathophysiology of obstructive sleep apnea to teach cardiopulmonary integration. Adv Physiol Educ. 2008;32:196–202. CrossRef
Javaheri S. A mechanism of central sleep apnea in patients with heart failure. N Eng J Med. 1999;341:949–54. CrossRef
Dean RT, Wilcox I. Possible atherogenic effects of hypoxia during obstructive sleep apnea. Sleep. 1993;16(8 suppl):S15–21. PubMed
Dimsdale JE, Coy T, Ziegler MG, et al. The effect of sleep apnea on plasma and urinary catecholamines. Sleep. 1995;18:377–81. PubMed
Born J, Lange T, Hansen K, et al. Effects of sleep and circadian rhythm on human circulating immune cells. J Immunol. 1997;158:4454–64. PubMed
Leproult R, Copinschi G, Buxton O, et al. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20:865–70. PubMed
von Kanel R, Loredo JS, Ancoli-Israel S, et al. Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest. 2007;131:733–9. CrossRef
Levy LM, Pepin J-L, Tamisier R, Neuder Y, Baguet J-P, Javaheri S. Prevalence and impact of central sleep apnea in heart failure. Sleep Med Clin. 2007;2:615–21. CrossRef
Oldenburg O, Bitter T, Vogt J, et al. Central and obstructive sleep apnea are associated with increased mortality in patients with long-term cardiac resynchronization therapy. J Am Coll Cardiol. 2011;54(Suppl A):E100. CrossRef
Ohmura T, Iwama Y, Kasai T, et al. Impact of predischarge nocturnal pulse oximetry (sleep-disordered breathing) on postdischarge clinical outcomes in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure. Am J Cardiol. 2014;113:697–700. CrossRefPubMed
Pinna GD, Robbi E, La Rovere MT, et al. Differential impact of body position on the severity of sleep disordered breathing in heart failure patients with obstructive versus central sleep apnoea. Eur J Heart Fail. 2015;17:1318–25. CrossRef
Leite FG, Rodrigues RC, Ribeiro RF, et al. The use of a mandibular repositioning device for obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2014;271:1023–9.
National Institute for Health and Care Excellence. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. 2008.
Arzt M, Floras JS, Logan AG, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial. Circulation. 2007;115:3173–80. CrossRefPubMed
Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015;373:1095–105. Recent, large randomized trial, adequately powered for cardiovascular endpoints, reporting an increase in mortality for those with CSA and HFrEF treated by ASV. CrossRefPubMedPubMedCentral
- Sleep-Disordered Breathing—Do We Have to Change Gears in Heart Failure?
Martin R. Cowie
- Springer US
Neu im Fachgebiet Kardiologie
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