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Epidemiology of Sleep-Disordered Breathing and Heart Failure: What Drives What

  • Epidemiology of Heart Failure (J Ho, Section Editor)
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Abstract

Purpose of Review

The bidirectional relationships that have been demonstrated between heart failure (HF) and central sleep apnea (CSA) demand further exploration with respect to the implications that each condition has for the other. This review discusses the body of literature that has accumulated on these relationships and how CSA and its potential treatment may affect outcomes in patients with CSA.

Recent Findings

Obstructive sleep apnea (OSA) can exacerbate hypertension, type 2 diabetes, obesity, and atherosclerosis, which are known predicates of HF. Conversely, patients with HF more frequently exhibit OSA partly due to respiratory control system instability. These same mechanisms are responsible for the frequent association of HF with CSA with or without a Hunter-Cheyne-Stokes breathing (HCSB) pattern. Just as is the case with OSA, patients with HF complicated by CSA exhibit more severe cardiac dysfunction leading to increased mortality; the increase in severity of HF can in turn worsen the degree of sleep disordered breathing (SDB). Thus, a bidirectional relationship exists between HF and both phenotypes of SDB; moreover, an individual patient may exhibit a combination of these phenotypes.

Summary

Both types of SDB remain significantly underdiagnosed in patients with HF and hence undertreated. Appropriate screening for, and treatment of, OSA is clearly a significant factor in the comprehensive management of HF, while the relevance of CSA remains controversial. Given the unexpected results of the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure trial, it is now of paramount importance that additional analysis of these data be expeditiously reported. It is also critical that ongoing and proposed prospective studies of this issue proceed without delay.

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Abbreviations

ADHF:

Acutely decompensated HF

AFib:

Atrial fibrillation

AHI:

Apnea-hypopnea index

ASV:

Adaptive servo-ventilation

BNP:

Brain natriuretic peptide

BP:

Blood pressure

CAI:

Central apnea index

CSA:

Central sleep apnea

CVD:

Cardiovascular disease

EDS:

Excessive daytime sleepiness

EPAP:

Expiratory positive airway pressure

HCM:

Hypertrophic cardiomyopathy

HCSB:

Hunter-Cheyne-Stokes breathing

HF:

Heart failure

HRQOL:

Health-related quality of life

HSAT:

Home sleep apnea testing

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

HTN:

Hypertension

IPAP:

Inspiratory positive airway pressure

IPS:

Inspiratory pressure support

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MLHFQ:

Minnesota living with HF questionnaire

MSNA:

Muscle sympathetic nerve activity

NREM:

Non-rapid eye movement sleep

NYHA:

New York Heart Association

OSA:

Obstructive sleep apnea

PAP:

Positive airway pressure

PND:

Paroxysmal nocturnal dyspnea

RCT:

Randomized controlled trial

REI:

Respiratory event index

SA:

Sleep apnea

SDB:

Sleep disordered breathing

S/T:

Spontaneous/timed

T2DM:

Type 2 diabetes mellitus

UA:

Upper airway

VT:

Ventricular tachyarrhythmia

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM, 87102, USA

    Sushma M. Dharia & Lee K. Brown

  2. Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, NM, USA

    Lee K. Brown

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Correspondence to Lee K. Brown.

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Sushma M. Dharia declares no conflict of interest. Lee K. Brown has participated in advisory panels for Philips Respironics and is an insurance claims reviewer for Considine and Associates, Inc. He coedits the sleep and respiratory neurobiology section of Current Opinion in Pulmonary Medicine and wrote on CPAP treatment for obstructive sleep apnea in UpToDate and on obstructive sleep apnea in Clinical Decision Support: Pulmonary Medicine and Sleep Disorders. He is currently coediting an issue of Sleep Medicine Clinics on positive airway pressure therapy. He serves on the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and chairs the New Mexico Respiratory Care Advisory Board.

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This article is part of the Topical Collection on Epidemiology of Heart Failure

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Dharia, S.M., Brown, L.K. Epidemiology of Sleep-Disordered Breathing and Heart Failure: What Drives What. Curr Heart Fail Rep 14, 351–364 (2017). https://doi.org/10.1007/s11897-017-0348-6

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