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Review
. 2013 Jun;19(6):431-44.
doi: 10.1016/j.cardfail.2013.04.005.

Sleep-disordered breathing in heart failure: identifying and treating an important but often unrecognized comorbidity in heart failure patients

Rami Khayat  1 , Roy Small, Lisa Rathman, Steven Krueger, Becky Gocke, Linda Clark, Laura Yamokoski, William T Abraham
Affiliations
Review

Sleep-disordered breathing in heart failure: identifying and treating an important but often unrecognized comorbidity in heart failure patients

Rami Khayat et al. J Card Fail. 2013 Jun.

Abstract

Sleep-disordered breathing (SDB) is the most common comorbidity in patients with heart failure (HF) and has a significant impact on quality of life, morbidity, and mortality. A number of therapeutic options have become available in recent years that can improve quality of life and potentially the outcomes of HF patients with SDB. Unfortunately, SDB is not part of the routine evaluation and management of HF, so it remains untreated in most HF patients. Although recognition of the role of SDB in HF is increasing, clinical guidelines for the management of SDB in HF patients continue to be absent. This article provides an overview of SDB in HF and proposes a clinical care pathway to help clinicians to better recognize and treat SDB in their HF patients.

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Conflict of interest statement

Disclosures: Drs. Khayat and Abraham are paid consultants to Respicardia, Inc. Ms.Clark is employed by Respicardia, Inc. Ms. Rathman is a speaker and consultant to Medtronic, Inc., a consultant to St. Jude Medical, and a member of the speakers bureau for Osuka. All other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Classic Cheyne-Stokes crescendo-decrescendo respiratory pattern with intervening apneic episodes.
Figure 2
Figure 2
Clinical evaluation pathway for sleep disordered breathing in patients with heart failure. Abbreviations: HF, heart failure; AFib, atrial fibrillation; SDB, sleep disordered breathing; PSG, polysomnography; OSA, obstructive sleep apnea; CSA, central sleep apnea.
Figure 3
Figure 3
The Mallampati airway classification system (I-IV scale). Class I: soft palate and entire uvula visible; Class II: soft palate and portion of uvula visible; Class III: soft palate visible (may include base of uvula); Class IV: soft palate not visible. (Image courtesy Jmarchn/Wikimedia Commons/Public Domain)
Figure 4
Figure 4
Polysomnogram of OSA in a patient with heart failure.
Figure 5
Figure 5
Polysomnogram of CSA in a patient with heart failure.
Figure 6
Figure 6
Treatment pathway for heart failure patients with obstructive sleep apnea (OSA). Adapted from J Clin Sleep Med. 2009;5:263–276. Abbreviations: ACE, angiotensin converting enzyme; AHI, apnea-hyponea index; CPAP, continuous positive airway pressure; HF, heart failure; OSA, obstructive sleep apnea; SDB, sleep disordered breathing; Tx, treatment
Figure 7
Figure 7
Treatment pathway for heart failure patients with central sleep apnea (CSA). Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ASV, adaptive servo-ventilation; CSA, central sleep apnea; CPAP, continuous positive airway pressure
See this image and copyright information in PMC

References

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