Sleep-disordered breathing in patients with heart failure

Abstract

Sleep-disordered breathing (SDB) is prevalent in patients with heart failure, and is associated with increased morbidity and mortality. SDB is proinflammatory, with nocturnal oxygen desaturations and hypercapnia appearing to play a pivotal role in the development of oxidative stress and sympathetic activation. Preliminary data suggest that attention to the diagnosis and management of SDB in patients with heart failure may improve outcomes. Ongoing research into the roles of comorbidities such as SDB as a treatment target may lead to better clinical outcomes and improved quality of life for patients with heart failure.

Keywords: Adaptive servoventilation; Clinical trials; Comorbidities; Heart failure; Outcomes; Positive airway pressure; Sleep apnea.

Figure 1

Multivariable Cox Proportional Hazards Survival Plots for Patients With Mild to No Sleep Apnea Versus Untreated Obstructive Sleep Apnea. Multivariable Cox proportional hazards plots showing worse survival of heart failure patients with untreated obstructive sleep apnea (OSA) than in those with mild to no sleep apnea (M-NSA) (hazard ratio = 2.81, p = 0.029) after adjusting for significant confounders (left ventricular ejection fraction, New York Heart Association functional class, and age). The adjusted survival curves are shown at the average values of these confounders. From Wang H et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 2007;49(15):1625–1631; with permission.

Figure 2

Interaction of the pathophysiology of sleep disordered breathing and heart failure.