Sleep disordered breathing in chronic heart failure

Abstract

Heart failure is a growing problem, placing an increasing burden on public health resources and continuing to exert a high toll in mortality and morbidity. Sleep disordered breathing (SDB) is also a major public health problem and is associated with an increased risk of fatal and non-fatal cardiovascular events. Current evidence suggests SDB, particularly central SDB, is more prevalent in patients with chronic heart failure (CHF) than in the general population, but is under-diagnosed as SDB symptoms are less prevalent in CHF. This is further hampered by the absence of a simple and accurate screening tool and limited access to sleep facilities to diagnose SDB in the large numbers of patients with CHF. The presence of SDB in patients with CHF imposes increased haemodynamic burdens and results in autonomic abnormalities. Central SDB is an independent marker of worse prognosis, and evidence is increasing that obstructive SDB is also associated with higher mortality in patients with CHF. Optimal treatment of central SDB in these patients remains uncertain. While evidence of efficacy of positive pressure ventilation is stronger in obstructive SDB, improvement in survival for patients with both CHF and SDB awaits definitive trials. This paper summarizes our current understanding of the pathophysiology of SDB in CHF, and the cardiovascular consequences, and reviews the evidence for the beneficial effects of treatment of SDB in patients with CHF.

Sleep-Disordered Breathing in Patients with Heart Failure

“…OSA is primarily a failure to maintain airway patency, although abnormal respiratory feedback loops may play a role in HF patients 32, 33 . In the general population, OSA patients tend to have a smaller upper airway which may be exacerbated by the nocturnal response of the pharyngeal dilator muscles to negative pressure and increasing carbon dioxide.…”

“…CSA is mainly due to the instability of the ventilatory control systems 33 . Breathing is controlled by a feedback loop where an increase in the arterial partial pressure of carbon dioxide (PaCO 2 ) stimulates breathing and a decrease inhibits it.…”

Impact of sleep disordered breathing severity on hemodynamics, autonomic balance and cardiopulmonary functional status in chronic heart failure

“…Because standard polysomnography cannot make the distinction between central from obstructive hypopnoea with certainty [38], and most episodes in our study were hypopnoeas, we analysed only severity of SDB rather than type. Similarly, Tamura et al [6] reported hypopnoea rather than apnoea as the predominant respiratory disturbance during sleep in their cohort of CHF patients with SDB, which provides additional justification for not differentiating between these two mechanisms when hypopnoeas predominate.…”

N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study

“…However, few data from large-scale and long-term observations in the Japanese general population are available, and the clinical significance of measuring NT-proBNP is unclear. In addition, it is known that worsened health-related quality of life (HR-QOL) state is bi-directionally associated with CVD, including chronic heart failure 15–17 . However, little is known about such association in the general population.…”