Contemporary Insights and Novel Treatment Approaches to Central Sleep Apnea Syndrome in Heart Failure

Abstract

Opinion Statement Central sleep apnea (CSA) is a common and under-diagnosed condition commonly associated with Cheyne-Stokes respiration. It is particularly prevalent in the heart failure population affecting up to 40% of all patients with heart failure. The pathophysiology associated with CSA is based on the underlying effects of hypoventilation and hyperventilation, with neurologic dysregulation of respiratory control as the primary defect. However, therapeutic options are limited due to the prevailing perception that CSA is a consequence, rather than cause of morbidity and mortality. At present, the main focus remains treating the underlying problem (ie intensifying heart failure therapeutics, decongestion), while additional suggestions of using acetazolamide, progesterone, nocturnal oxygen, and theophylline have not been validated with contemporary clinical trials. Positive pressure ventilation is currently the primary recommendation for all patients with sleep-disordered breathing (CSA included), and in some patients may effectively reduce the apnea-hypopnea index. However, significant research is ongoing to determine how to treat this complex patient population.

The effect of surgical and non-surgical weight loss on N-terminal pro-B-type natriuretic peptide and its relation to obstructive sleep apnea and pulmonary function

“…The association between sleep apnea and heart failure is well documented [ 43 , 44 ]. NT-proBNP levels might therefore be expected to be particularly high in patients with OSA.…”

The Evaluation of the Relationships Between Sleep Apnea Syndrome and Depression/Anxiety Disorder

“…The patients respond by making marks on the scale. The scoring for items 1,3,5,6,8,10,11,13 is in the form of 3, 2, 1, 0. Items 2, 4, 7, 9, 12, 14 are scored as 0, 1, 2, 3.…”

“…These changes in sleep duration lead to neuropsychiatric symptoms such as excessive daytime sleepiness, tiring easily, psychomotor slowness, perception disturbances, forgetfulness, attention deficit, concentration problems, decreased interest, decreased work performance, and sexual problems [6][7][8] .…”

“…Sleep continuity is disturbed, the superficial sleep duration increases and deep sleep duration decreases in these patients with complaints of excessive daytime sleepiness, witnessed apnea and snoring. These changes in sleep duration lead to neuropsychiatric symptoms such as excessive daytime sleepiness, tiring easily, psychomotor slowness, perception disturbances, forgetfulness, attention deficit, concentration problems, decreased interest, decreased work performance, and sexual problems [6][7][8] . Some studies have reported depression and decreased quality of life in SAS patients 9 .…”

Palliative care in cardiology

“…Poruchy dýchání spojené se spánkem (centrální nebo obstrukční spánková apnoe) se vyskytují u pacientů s chronickým srdečním selháním poměrně často [38,39]. Na tuto komorbiditu je třeba myslet, protože účinná léčba může opět významně zlepšit kvalitu života.…”