Sleep Disordered Breathing and Heart Failure: What Does the Future Hold?

Area of Science:

• Cardiology
• Sleep Medicine
• Respiratory Medicine

Background:

• Sleep-disordered breathing (SDB) is prevalent in heart failure (HF) patients, particularly central sleep apnea in severe disease.
• SDB is linked to poor prognosis, sleep disruption, hypoxemia, hemodynamic changes, and sympathetic activation.

Purpose of the Study:

• To evaluate the efficacy and safety of mask-based positive airway pressure (PAP) therapies for SDB in HF patients.
• To determine the necessity for further randomized outcome studies on SDB treatments in various HF populations.

Main Methods:

• Review of recent randomized trials investigating cardiovascular outcomes of SDB treatment in chronic HF with reduced ejection fraction.
• Analysis of existing data on the impact of SDB on sleep quality, respiratory physiology, and prognosis in HF.

Main Results:

• Recent trials on central sleep apnea in chronic HF with reduced ejection fraction yielded neutral or potentially harmful cardiovascular outcomes, including increased sudden death.
• PAP therapies can improve sleep quality and normalize respiratory physiology but have not consistently translated to improved cardiovascular outcomes.

Conclusions:

• Surrogate endpoints like improved sleep and respiratory metrics are insufficient for assessing therapeutic efficacy in HF patients with SDB.
• Further randomized outcome studies are crucial to establish the role of mask-based therapies and new interventions (e.g., phrenic nerve stimulators) in HF with SDB.
• The appropriateness of SDB treatment requires further investigation across different HF phenotypes (reduced/preserved ejection fraction, decompensated HF).