Research Priorities for Patients with Heart Failure and Central Sleep Apnea. An Official American Thoracic Society Research Statement

Abstract

Background: Central sleep apnea (CSA) is common among patients with heart failure and has been strongly linked to adverse outcomes. However, progress toward improving outcomes for such patients has been limited. The purpose of this official statement from the American Thoracic Society is to identify key areas to prioritize for future research regarding CSA in heart failure.Methods: An international multidisciplinary group with expertise in sleep medicine, pulmonary medicine, heart failure, clinical research, and health outcomes was convened. The group met at the American Thoracic Society 2019 International Conference to determine research priority areas. A statement summarizing the findings of the group was subsequently authored using input from all members.Results: The workgroup identified 11 specific research priorities in several key areas: 1) control of breathing and pathophysiology leading to CSA, 2) variability across individuals and over time, 3) techniques to examine CSA pathogenesis and outcomes, 4) impact of device and pharmacological treatment, and 5) implementing CSA treatment for all individualsConclusions: Advancing care for patients with CSA in the context of heart failure will require progress in the arenas of translational (basic through clinical), epidemiological, and patient-centered outcome research. Given the increasing prevalence of heart failure and its associated substantial burden to individuals, society, and the healthcare system, targeted research to improve knowledge of CSA pathogenesis and treatment is a priority.

Keywords: heart failure; respiration; sleep apnea.

Figure 1.

Schematic of ventilatory-control-system inputs/afferents that converge on integrating respiratory centers in the pons and medulla. Chemoreceptors include both peripheral and central centers. Other physical inputs to breathing include lung stretch and irritant receptors; movement/stretch receptors in muscles and joints, including receptors within the chest wall, larynx, and respiratory muscles (including in the upper airway); and peripheral pain receptors. Higher brain centers impact breathing via volitional drive, emotion, and sleep-versus-wake state (wakefulness drive to breathe). + = stimulate; − = inhibit; ± = stimulate or inhibit; C = location of respiratory groups in the medulla. Adapted by permission from Reference .