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Sleep disordered breathing in chronic heart failure.

Austin Chin Chwan Ng¹, Saul Benedict Freedman

¹Faculty of Medicine, Concord RG Hospital, The University of Sydney, Hospital Road, Concord, 2139 NSW, Australia. austin.ng@email.cs.nsw.gov.au

Heart Failure Reviews

|June 13, 2008

Summary

Sleep disordered breathing (SDB) is common in heart failure patients but often undiagnosed. Treating SDB may improve outcomes, though optimal strategies require further research.

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Area of Science:

Cardiology
Pulmonology
Sleep Medicine

Background:

Heart failure (HF) is a growing public health concern with high mortality and morbidity.
Sleep disordered breathing (SDB) is prevalent in chronic heart failure (CHF) patients, increasing cardiovascular event risk.
SDB is under-diagnosed in CHF due to subtle symptoms and limited diagnostic access.

Purpose of the Study:

To summarize the pathophysiology and cardiovascular consequences of SDB in CHF.
To review the evidence for beneficial effects of SDB treatment in CHF patients.

Main Methods:

Literature review of SDB in chronic heart failure.
Analysis of pathophysiology, cardiovascular consequences, and treatment efficacy.

Main Results:

Central SDB is common in CHF and an independent marker of poor prognosis.
Obstructive SDB is also linked to increased mortality in CHF patients.
SDB in CHF exacerbates hemodynamic burden and causes autonomic dysfunction.

Conclusions:

SDB is a significant, under-recognized comorbidity in CHF with serious cardiovascular implications.
Optimal treatment for SDB in CHF, particularly central SDB, requires further investigation.
Positive pressure ventilation shows efficacy in obstructive SDB; survival benefits in CHF patients with SDB need definitive trials.