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Sleep-Disordered Breathing in Heart Failure: Phenotypes, Mechanisms, and Precision Approach
Huijie Yi1, Luciano F Drager2, Xiao Wang3
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Respiratory and Sleep Medicine, Peking University People's Hospital, Beijing, China.
Journal of Cardiac Failure
|July 10, 2026
Summary
Sleep-disordered breathing (SDB) is common in heart failure (HF) but treatments like CPAP lack proven mortality benefits. Personalized approaches using physiological markers are needed for better SDB management in HF patients.
Area of Science:
- Cardiology
- Pulmonology
- Sleep Medicine
Background:
- Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is prevalent in heart failure (HF).
- SDB is linked to adverse cardiac remodeling, arrhythmias, and poor clinical outcomes in HF patients.
- Current SDB treatments in HF show limited success in reducing mortality or hospitalizations despite improving some physiological markers.
Purpose of the Study:
- To review the current understanding of SDB in HF.
- To evaluate the effectiveness of existing and emerging SDB therapies in HF.
- To advocate for precision-based, phenotype-specific management strategies for SDB in HF.
Main Methods:
- Review of existing literature on SDB in HF.
- Analysis of clinical trial data for CPAP, adaptive servo-ventilation, and alternative therapies.
- Evaluation of novel physiological markers for risk stratification.
Main Results:
- Continuous positive airway pressure (CPAP) improves symptoms and oxygenation in OSA but has not demonstrated reduced mortality in HF.
- Adaptive servo-ventilation shows neutral or adverse long-term outcomes in CSA, suggesting it may be a marker of HF severity.
- Novel markers like hypoxic burden and autonomic responses may better predict treatment response than traditional metrics.
Conclusions:
- Conventional SDB treatments lack consistent mortality benefits in HF.
- Central sleep apnea in HF may be a marker of disease severity rather than a direct therapeutic target.
- A phenotype-specific, precision-based approach integrating HF characteristics and physiological markers is crucial for optimizing SDB management in heart failure.
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