Sleep-disordered breathing in heart failure.

Area of Science:

• Cardiology
• Sleep Medicine
• Pulmonology

Background:

• Sleep-disordered breathing (SDB) affects over 50% of heart failure (HF) patients.
• SDB, including obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), negatively impacts cardiac function and prognosis.
• Current management strategies for SDB in HF patients require further clarification, particularly for CSA.

Purpose of the Study:

• To review the impact of SDB on cardiac function and patient outcomes in HF.
• To evaluate the efficacy and safety of current treatment modalities for SDB in HF patients.
• To highlight the need for further research into optimal CSA management in HF.

Main Methods:

• Review of existing literature on SDB in HF.
• Analysis of clinical trial data, including CPAP and ASV for OSA and CSA.
• Discussion of the implications for clinical practice and future research directions.

Main Results:

• Continuous positive airway pressure (CPAP) shows some benefit for OSA in HF but lacks strong evidence for mortality improvement.
• The CANPAP trial found no survival or hospitalization benefit for CPAP in systolic HF patients with CSA.
• Adaptive servoventilation (ASV) for CSA in HF increased mortality in the SERVE-HF trial and did not improve outcomes.

Conclusions:

• The optimal management of CSA in HF patients remains uncertain.
• While CPAP may benefit OSA symptoms and cardiac function, its impact on mortality in HF is weakly supported.
• ASV is contraindicated in HF patients due to increased mortality risk. Further research is essential for CSA treatment strategies in HF.