Sleep in congestive heart failure

Abstract

Breathing disorders during sleep are common in congestive heart failure (CHF). Sleep-disordered breathing (SDB) in CHF can be broadly classified as 2 types: central sleep apnea with Cheyne-Stokes breathing, and obstructive sleep apnea. Prevalence of SDB ranges from 47% to 76% in systolic CHF. Treatment of SDB in CHF may include optimization of CHF treatment, positive airway pressure therapy, and other measures such as theophylline, acetazolamide, and cardiac resynchronization therapy. Periodic limb movements are also common in CHF.

Fig. 1

Polysomnogram showing Cheyne-Stokes breathing. There are crescendo-decrescendo changes in tidal volume that result in central apneas (as shown in the chest and abdominal respiratory movements in the polysomnogram).

Fig. 2

Polysomnogram showing obstructive sleep apnea. There are repetitive episodes of oxygen desaturation episodes despite ongoing respiratory effort (as shown by thoracic and abdominal respiratory movements), and arousals. Apnea exists when airflow is less than 20% of baseline for at least 10 seconds in adults. Hypopnea exists when airflow decreases at least 30% from baseline, there is diminished airflow lasting at least 10 seconds, at least 90% of the duration of diminished airflow is spent with airflow that is at least 30% less than baseline, and decreased airflow is accompanied by at least 4%oxyhemoglobin desaturation. Respiratory effort related arousals (RERAs) exist when there is a sequence of breaths that lasts at least 10 seconds, is characterized by increasing respiratory effort or flattening of the nasal pressure waveform, and leads to an arousal from sleep, but does not meet the criteria of an apnea or hypopnea.

Fig. 3

A suggested algorithm for management of sleep-disordered breathing in congestive heart failure.