Association between Obstructive Sleep Apnea and Heart Failure in Adults—A Systematic Review

Abstract

Background: Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. Methods: We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. Results: Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. Conclusions: The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.

Sleep Apnea and Atrial Fibrillation: Clinical Features and Screening Diagnostic Options

“…In our study, patients with hypertension prevailed in each group, but no significant difference was found between them ( p = 0.087). According to Polecka A. et al, OSA is closely associated with adverse outcomes in patients with HF [ 15 ]. Patients with sleep apnea also presented more frequently with HF and type 2 diabetes (OR 2.9; 95% CI: 1.4–5.9 ( p = 0.004) and OR 3.6; 95% CI: 1.5–8.3; p = 0.001, respectively).…”

Health consequences of Obstructive Sleep Apnoea Syndrome

“…Sleep apnea, whether in the presence or absence of HF, is associated with a higher risk of negative cardiovascular outcomes, including aggravation of heart failure-related symptoms, increased hospitalizations, and higher mortality rates. [21]…”

Obstructive Sleep Apnea as a Key Contributor to Mental Stress-Induced Myocardial Ischemia in Female Angina Patients with No Obstructive Coronary Artery Disease

“…[8][9][10][11] There exists evidence that obstructive sleep apnea (OSA) is autonomously linked to obstructive coronary heart disease, hypertension, and sudden cardiac death. [12][13][14][15][16] OSA is typified by recurrent upper airway blockage during sleep, leading to reduced arterial oxygen saturation, and apnea/hypopnea events are frequently terminated by micro arousals. 13,17,18 Due to periodic nocturnal hypoxia, 19,20 patients with OSA experience systemic inflammatory activation, 21 oxidative stress, 22 endothelial dysfunction, 23 and sympathetic nervous system overactivity, 24,25 which subsequently impairs the cardiovascular system.…”