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Sleep and breathing disorders in heart failure
Shahrokh Javaheri1, Robin Germany2
1Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Cardiology, Ohio State University, Columbus, OH, United States.
Handbook of Clinical Neurology
|August 28, 2022
Summary
Heart failure patients frequently experience sleep apnea (OSA/CSA), leading to poor outcomes. Early diagnosis and treatment of these sleep disorders are crucial for improving patient survival and reducing hospital readmissions.
Area of Science:
- Cardiology
- Sleep Medicine
- Pulmonology
Background:
- Sleep disorders, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), are common in heart failure (HF) patients.
- Approximately 50% of HF patients suffer from either OSA or CSA, impacting sleep quality and efficiency.
- Sleep apnea in HF is linked to adverse physiological consequences like altered blood gases and intrathoracic pressure swings.
Purpose of the Study:
- To review the prevalence and impact of sleep disorders in heart failure.
- To discuss the pathological consequences of sleep apnea in HF.
- To evaluate current treatment strategies and their effect on patient outcomes.
Main Methods:
- Review of polysomnographic studies in heart failure patients.
- Analysis of existing literature on the association between sleep apnea and HF outcomes.
- Examination of data from randomized controlled trials (RCTs) on sleep apnea treatments in HF.
Main Results:
- Sleep apnea (OSA/CSA) is prevalent in HF, causing sleep fragmentation and impaired gas exchange.
- Both OSA and CSA are associated with increased hospital readmissions and mortality in HF patients.
- Positive airway pressure devices may increase mortality in HF with CSA; phrenic nerve stimulation shows mixed results without proven survival benefits.
Conclusions:
- Sleep disorders are significant comorbidities in heart failure.
- Effective identification and management of sleep apnea in HF patients are essential for improving long-term prognosis.
- Further RCTs are needed to establish safe and effective treatments for sleep apnea in heart failure.
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