Management of Obstructive Sleep Apnea in Patients With Heart Failure

Abstract

Sleep apnea is traditionally classified as obstructive sleep apnea (OSA), which occurs when the upper airway collapses due to the relaxation of oropharyngeal musculature, and central sleep apnea occurs when the brainstem cannot stimulate breathing. Most sleep apnea in patients with heart failure (HF) results from coexisting OSA and central sleep apnea (CSA), or complex sleep apnea syndrome. OSA and CSA are common in HF and can be involved in its progression by exposure to the heart to intermittent hypoxia, increased preload and afterload, activating sympathetic, and decreased vascular endothelial function. A majority of treatments have been investigated in patients with CSA and HF; however, less or short-term randomized trials demonstrated whether treating OSA in patients with HF could improve morbidity and mortality. OSA could directly influence the patient's recovery. This review will focus on past and present studies on the various therapies for OSA in patients with HF and summarize CSA treatment options for reasons of reference and completeness. More specifically, the treatment covered include surgical and non-surgical treatments and reported the positive and negative consequences for these treatment options, highlighting possible implications for clinical practice and future research directions.

Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea

“…Despite the therapies available to us and device treatments, SA has a prevalence of around 40% in patients with HF; furthermore, while OSA is a predominantly nocturnal phenomenon, CSA is present at night as well as during the day [1]. The presence of both CSA and OSA increases sympathetic activation and the risk of arrhythmias, leading to worsening of symptoms and reduced survival in HF [3][4][5][6][7]. Despite numerous therapeutic attempts with NIV, so far, no treatment of CSA has shown a prognostic benefit.…”

“…Despite recent advancements in the pharmaceutical management of HF, the prognosis is still poor [3]. Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are among the most common comorbidities that are strongly associated with all-cause mortality in more than 50% of patients with HF [4,5]. Several therapeutic approaches have been applied to address CSA and OSA, but none of these pharmacologic interventions have been shown to significantly improve patients' prognoses for HF [6][7][8][9].…”

Sleep Apnea and Heart Failure—Current State-of-The-Art

“…Surgical interventions for OSA play a role by targeting anatomical obstructions in the airway. Among these, uvulopalatopharyngoplasty (UPPP) is designed to enlarge the airway by removing or repositioning tissues such as the uvula, tonsils, and part of the soft palate [47]. Although traditionally popular, uvulopalatopharyngoplasty (UPPP) has seen a decline in usage due to its variable success rates and post-operative complications, such as velopharyngeal insufficiency and foreign body sensation [48].…”

Novel Therapeutic Devices in Heart Failure

“…OSA/CSA increases SNS, RAAS activation, oxidative stress, cell apoptosis, endothelial dysfunction and, as a result, remodeling and fibrosis of the heart [ 31 , 32 ]. These effects are common to the OSA/CSA and HF pathophysiology and accelerate HF progression, despite different mechanisms leading to these consequences [ 33 ].…”