Sleep disordered breathing in patients with heart failure

Abstract

Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure
(HF). Both its forms — central and obstructive sleep apnea — are highly prevalent in this
population. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HF
and is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed.
Therefore, early detection of SDB seems to be of primary importance, especially in the presence
of new diagnostic and therapeutic methods. Treatment with continuous positive airway
pressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually all
HF patients with obstructive and in 50% with central sleep apnea. For those in whom central
sleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended.
Although no randomized, controlled trials have shown improvement in mortality, several observational
studies have shown that effective treatment of both forms of sleep apnea with various
positive airway pressure devices improves survival of HF patients. Currently, 2 large trials with
newer masked based therapies with adaptive servoventilation are in progress. This article is
a brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy of
SDB.