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Management of Sleep Disordered Breathing in Patients with Heart Failure

  • Pharmacologic Therapy (W.H.W. Tang, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor?

Recent Findings

Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm.

Summary

Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient’s heart failure management should remain the priority of medical care.

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  1. School of Medicine, University of Maryland, Baltimore, MD, USA

    Connor P. Oates, Manjula Ananthram & Stephen S. Gottlieb

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  1. Connor P. Oates
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Correspondence to Stephen S. Gottlieb.

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Manjula Ananthram and Connor P. Oates declare no conflicts of interest. Stephen S. Gottlieb reports grants from Respicardia and grants from Resmed, outside the submitted work.

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Oates, C.P., Ananthram, M. & Gottlieb, S.S. Management of Sleep Disordered Breathing in Patients with Heart Failure. Curr Heart Fail Rep 15, 123–130 (2018). https://doi.org/10.1007/s11897-018-0387-7

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