Targeting Sleep Disordered Breathing to Prevent Heart Failure: What is the Evidence?

Abstract

The inter-relationships of sleep disordered breathing (SDB) and heart failure (HF) are becoming increasingly well-characterized. The pathways linking the two entities are likely bi-directional and key underlying pathophysiological mechanisms at play include autonomic nervous system fluctuations, intermittent hypoxia, intrathoracic cardiac mechanical influences, rostral fluid shifts and up-regulation of systemic inflammation and oxidative stress. Given the increased morbidity and mortality which accompanies heart failure, the recognition and treatment of factors such as sleep disordered breathing is paramount in order to mitigate these untoward downstream health consequences. Recently, the management of HF requires combining several treatments including pharmacotherapy, electrophysiologic therapy, and cardiac surgery to target the various complex facets of HF. Despite the development of HF treatments, HF remains to pose a great challenge to the general cardiologist. Herein we review several interventional studies highlighting the effects of treating SDB on HF morbidity and mortality with a notable predominance of literature focusing on HF reduced ejection fraction (HF-REF) as well as emerging data describing SDB treatment effects in HF preserved EF (HF-PEF). These data are compelling yet with intrinsic limitations which underscore the need for appropriately powered clinical trials employing rigorous clinical trials methodology to examine the effect of SDB treatment on HF progression and associated adverse outcomes.

ASC Methylation and Interleukin-1β Are Associated with Aerobic Capacity in Heart Failure

“…These inflammatory cytokines also play a role in altering skeletal muscle function due to their catabolic effects (1). Chronic inflammation in HF leads to altered breathing patterns, such as inspiratory muscle weakness (21). Thus, inflammation is a key component of pathophysiological changes that lead to decreased aerobic capacity in persons with HF.…”

Sleep-disordered breathing in heart failure

“…This prevalence varies with the etiology of heart failure, with the highest prevalence in ischemic, hypertensive, and myocardial heart failure [3 ▪ ]. The pathophysiological mechanisms linking SDB and heart failure have been increasingly elucidated, revealing that intermittent hypoxemia and fragmented sleep patterns significantly contribute to the progression of heart failure [4]. Apneic episodes result in increased sympathetic nervous system activation, and negative intrathoracic pressures causing increased ventricular wall tension and lower stroke volume.…”