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Contemporary Insights and Novel Treatment Approaches to Central Sleep Apnea Syndrome in Heart Failure

  • Heart Failure (W Tang, Section Editor)
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Opinion statement

Central sleep apnea (CSA) is a common and under-diagnosed condition commonly associated with Cheyne-Stokes respiration. It is particularly prevalent in the heart failure population affecting up to 40 % of all patients with heart failure. The pathophysiology associated with CSA is based on the underlying effects of hypoventilation and hyperventilation, with neurologic dysregulation of respiratory control as the primary defect. However, therapeutic options are limited because of the prevailing perception that CSA is a consequence, rather than cause of morbidity and mortality. At present, the main focus remains treating the underlying problem (ie, intensifying heart failure therapeutics, decongestion), whereas additional suggestions of using acetazolamide, progesterone, nocturnal oxygen, and theophylline have not been validated with contemporary clinical trials. Positive pressure ventilation is currently the primary recommendation for all patients with sleep-disordered breathing (CSA included), and in some patients may effectively reduce the apnea-hypopnea index. However, significant research is ongoing to determine how to treat this complex patient population.

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Acknowledgments

The authors would like to thank Dr. Robin Germany, Chief Medical Officer of Respicardia Inc, (Minnetonka, MN) and Clinical Assistant Professor at the University of Oklahoma for her critical review of our manuscript.

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Conflict of Interest

Dr. Ryan L. Grayburn and Ms. Yaquta Kaka have no relationships to disclose. Dr. Wilson Tang is a site investigator for the Respicardia clinical study, but does not receive any personal honorarium or support. Dr. Tang is a section editor for Current Treatment Options in Cardiovascular Medicine.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, USA

    Ryan L. Grayburn DO & W. H. Wilson Tang MD

  2. Northeast Ohio Medical University, Rootstown, OH, USA

    Yaquta Kaka BS

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  1. Ryan L. Grayburn DO
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Correspondence to W. H. Wilson Tang MD.

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This article is part of the Topical Collection on Heart Failure

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Grayburn, R.L., Kaka, Y. & Tang, W.H.W. Contemporary Insights and Novel Treatment Approaches to Central Sleep Apnea Syndrome in Heart Failure. Curr Treat Options Cardio Med 16, 322 (2014). https://doi.org/10.1007/s11936-014-0322-5

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