Current Cardiology Reports

, Volume 7, Issue 3, pp 211–215 | Cite as

The link between obstructive sleep apnea and heart failure: Underappreciated opportunity for treatment

  • Matthew T. Naughton
Article

Abstract

Obstructive sleep apnea (OSA) is a newly recognized risk factor for the development of systemic hypertension, ischemic heart disease and congestive heart failure. Mechanisms responsible for these links include OSA-related hypoxemia and arousal from sleep-induced increased sympathetic activity, large negative intrathoracic pressure-induced increased left ventricular transmural pressure gradient, and impaired vagal activity plus oxygen radial formation. Secondary phenomena include increased platelet aggregability, insulin resistance, and endothelial dysfunction with reduced endogenous nitric oxide production. Safe nonpharmacologic, nonsurgical therapy, namely continuous positive airway pressure, can attenuate OSA, and improve cardiac function and quality of life. Searching for signs or symptoms of OSA from the patient (or bed partner), namely loud habitual snoring, apneas, nocturnal choking, orthopnea, paroxysmal nocturnal dyspnea, excessive daytime sleepiness, or cardiovascular disease, which is difficult to control, may reward the curious physician with another treatment avenue.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Young T, Palta M, Dempsey J, et al.: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993, 328:1230–1235.PubMedCrossRefGoogle Scholar
  2. 2.
    Kenchaiah S, Evans JC, Levy D, et al.: Obesity and the risk of heart failure. N Engl J Med 2002, 347:305–313.PubMedCrossRefGoogle Scholar
  3. 3.
    Solin P, Roebuck T, Johns DP, et al.: Peripheral and central ventilatory responses in central sleep apnea with and without heart failure. Am J Respir Crit Care Med, 2000, 162:2194–2200.PubMedGoogle Scholar
  4. 4.
    Solin P, Bergin P, Richardson M, et al.: Influence of pulmonary capillary wedge pressure on CSA in heart failure. Circulation 1999, 99:1574–1579.PubMedGoogle Scholar
  5. 5.
    Brooks D, Horner RL, Kozar LF, et al.: Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. J Clin Invest 1997, 99:106–109.PubMedGoogle Scholar
  6. 6.
    Shahar E, Whitney CW, Redline S, et al.: Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001, 163:19–25.PubMedGoogle Scholar
  7. 7.
    Worsnop CJ, Naughton MT, Barter CE, et al.: The prevalence of obstructive sleep apnea in hypertensives. Am J Resp Crit Care Med 1998, 157:111–115.PubMedGoogle Scholar
  8. 8.
    Nieto FJ, Young TB, Lind BK, et al.: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000, 283:1829–36.PubMedCrossRefGoogle Scholar
  9. 9.
    Peppard PE, Young T, Palta M, Skatrud J: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000, 342:1378–1384.PubMedCrossRefGoogle Scholar
  10. 10.
    Logan AG, Perlikowski SM, Mente A, et al.: High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001, 19:2271–2277.PubMedCrossRefGoogle Scholar
  11. 11.
    Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al.: Ambulatory blood pressure following therapeutic and sub-therapeutic nasal CPAP for OSA: a randomised controlled parallel trial. Lancet 2002, 359:204–210.PubMedCrossRefGoogle Scholar
  12. 12.
    Becker HF, Jerrentrup A, Ploch T, et al.: Effect of nasal CPAP treatment on blood pressure in patients with OSA. Circulation 2003, 107:68–73.PubMedCrossRefGoogle Scholar
  13. 13.
    Chobanian AV, Bakris GL, Black HR, et al.: Joint national committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension 2003, 42:1206–1252. This paper accepts OSA as an important reversible cause of hypertension.PubMedCrossRefGoogle Scholar
  14. 14.
    Mooe T, Franklin KA, Wiklund U, et al.: Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease. Chest 2000, 117:1597–1602.PubMedCrossRefGoogle Scholar
  15. 15.
    Koehler U, Trautmann M, Trautmann R, et al.: Does sleep apnea increase the risk of myocardial infarct during sleep? Z Kardiol 1999, 88:410–417.PubMedCrossRefGoogle Scholar
  16. 16.
    Aboyans V, Cassat C, Lacroix P, et al.: Is the morning peak of acute myocardial infarction’s onset due to sleep-related breathing disorders? A prospective study. Cardiology 2000, 94:188–192.PubMedCrossRefGoogle Scholar
  17. 17.
    Hung J, Whitford EG, Parsons RW, Hillman DR: Association of sleep apnea with myocardial infarction in men. Lancet 1990, 336:261–264.PubMedCrossRefGoogle Scholar
  18. 18.
    Peker Y, Hedner J, Norum J, et al.: Increased incidence of cardiovascular disease in middle-aged men with OSA: a 7-year follow-up. Am J Respir Crit Care Med 2002, 166:159–165.PubMedCrossRefGoogle Scholar
  19. 19.
    Peled N, Abinader EG, Pillar G, et al.: Nocturnal ischemic events in patients with OSA syndrome and ischemic heart disease: effects of continuous positive air pressure. J Am Coll Cardiol 1999, 34:1744–1749.PubMedCrossRefGoogle Scholar
  20. 20.
    Franklin KA, Nilsson JB, Sahlin C, Naslund U: Sleep apnoea in nocturnal angina. Lancet 1995, 345:1085–1087.PubMedCrossRefGoogle Scholar
  21. 21.
    Lavie L, Vishnevsky A, Lavie P: Evidence for lipid peroxidation in obstructive sleep apnea. Sleep 2004, 27:123–128.PubMedGoogle Scholar
  22. 22.
    Ip MS, Tse HF, Lam B, et al.: Endothelial function in obstructive sleep apnea and response to treatment. Am J Resp Crit Care Med 2004, 169:348–353.PubMedCrossRefGoogle Scholar
  23. 23.
    Kato M, Roberts-Thompson P, Phillips BG, et al.: Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 102:2607–2610.Google Scholar
  24. 24.
    Chan J, Sanderson J, Chan W, et al.: Prevalence of sleep-disordered breathing in diastolic heart failure. Chest 1997, 111:1488–1493.PubMedGoogle Scholar
  25. 25.
    Sin DD, Fitzgerald F, Parker JD, et al.: Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999, 160:1101–1106.PubMedGoogle Scholar
  26. 26.
    Solin P, Kaye DM, Little PHJ, et al.: Impact of sleep apnea on sympathetic nervous system activity in heart failure. Chest 2003, 123:1119–1126.PubMedCrossRefGoogle Scholar
  27. 27.
    Laaban JP, Pascal-Sebaoun S, Bloch E, et al.: Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest 2002, 122:1133–1238.PubMedCrossRefGoogle Scholar
  28. 28.
    Alchanatasis M, Tourkohoriti G, Kosmas EN, et al.: Evidence for left ventricular dysfunction in patients with obstructive sleep apnea syndrome. Eur Respir J 2002, 20:1239–1245.CrossRefGoogle Scholar
  29. 29.
    Fung JWH, Li TST, Choy KL, et al.: Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 2002, 121:422–429.PubMedCrossRefGoogle Scholar
  30. 30.
    Amin RS, Kimball TR, Bean JA, et al.: Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med 2002, 165:1395–1399.PubMedCrossRefGoogle Scholar
  31. 31.
    Fletcher EC, Proctor M, Yu J, et al.: Pulmonary edema develops after recurrent obstructive apneas. Am J Respir Crit Care Med 1999, 160:1688–1696.PubMedGoogle Scholar
  32. 32.
    Parker JD, Brooks D, Kozar LF, et al.: Acute and chronic effects of airway obstruction on canine left ventricular performance. Am J Respir Crit Care Med 1999, 160:1888–1896.PubMedGoogle Scholar
  33. 33.
    Scharf SM, Bianco JA, Tow DE, et al.: The effects of large negative intrathoracic pressure on left ventricuklar function in patients with coronary artery disease. Circulation 1981, 63:871–875.PubMedGoogle Scholar
  34. 34.
    Serizawa T, Vogel M, Apstein CS, Grossman W: Comparison of acute alterations in left ventricular relaxation in left ventricular relaxation and diastolic chamber stiffness induced by hypoxia and ischemia. J Clin Invest 1981, 68:91–102.PubMedCrossRefGoogle Scholar
  35. 35.
    Guardiola J, Yu J, Hasan N, Fletcher EC: Evening and morning blood gases in patients with OSA. Sleep Med 2004, 5:489–493.PubMedCrossRefGoogle Scholar
  36. 36.
    Buda AJ, Schroeder JS, Guilleminault C: Abnormalities of pulmonary artery wedge pressures in sleep-induced apnea. Int J Cardiol 1981, 1:67–74.PubMedCrossRefGoogle Scholar
  37. 37.
    Cloward TV, Walker JM, Farney RJ, Anderson JL: Left ventricular hypertrophy is a common echocardiographic abnormality in severe OSA and reverses with CPAP. Chest 2003, 124:594–601.PubMedCrossRefGoogle Scholar
  38. 38.
    Malone S, Liu PP, Holloway R, et al.: OSA in patients with idiopathic dilated cardiomyopathy: effects of CPAP. Lancet 1991, 38:1480–1484.Google Scholar
  39. 39.
    Krieger J, Grucker D, Sforza E, et al.: LVEF in OSA. Effect of long term treatment with nasal continuous positive airway pressure. Chest 1991, 100:917–921.PubMedGoogle Scholar
  40. 40.
    Kaneko Y, Floras JS, Usui K, et al.: Cardiovascular effects of CPAP in patients with CHF and OSA. N Engl J Med 2003, 348:1233–1241. This study confirmed prior before and after studies with a randomized controlled trial that CPAP augments cardiac function and reduces blood pressure and LV chamber size in patients with CHF and OSA over 1 month.PubMedCrossRefGoogle Scholar
  41. 41.
    Mansfield D, Gollogly NC, Bergin P, et al.: Controlled trial of CPAP in OSA and heart failure. Am J Respir Cit Care Med 2004, 169:361–366. This study published soon after Kaneko et al. [40 ] also confirmed CPAP augmented cardiac function, reduced sympathetic activity, and improved quality of life in CHF patients with OSA over 3 months.CrossRefGoogle Scholar
  42. 42.
    Artz M, Harth M, Blumberg F, Pfeifer M: Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in congestive heart failure. Am J Respir Crit Care Med 2004, 169:A747.Google Scholar
  43. 43.
    Robinson GV, Stradling JR, Davies RJO, Roberts ISD: Post mortem diagnosis of fatal obstructive sleep apnea. Histopathology 2004, 45:542.PubMedCrossRefGoogle Scholar
  44. 44.
    Lindberg E, Janson C, Svardsudd K, et al.: Increased mortality among sleepy snorers: a prospective population study. Thorax 1998, 53:631–637.PubMedCrossRefGoogle Scholar
  45. 45.
    Veale D, Chailleux E, Hoorelbeke-Ramon, et al.: Mortality of sleep apnea patients treated by CPAP registered with ANTIADIR. Eur Resp J 2000, 15:326–331.CrossRefGoogle Scholar
  46. 46.
    Marti G, Sampol G, Munoz X, et al.: Mortality in severe sleep apnea/hypopnoea syndrome patients: impact of treatment. Eur Resp J 2002, 20:1511–1518.CrossRefGoogle Scholar
  47. 47.
    Roebuck T, Solin P, Kaye DM, et al.: Increased long term mortality due to sleep apnea in heart failure is yet to be proven. Eur Respir J 2004, 23:735–740.PubMedCrossRefGoogle Scholar
  48. 48.
    Bersten AD, Holt AW, Vedig A, et al.: Treatment of severe cardiogenic pulmonary edema with CPAP. N Engl J Med 1991, 325:1825–1830.PubMedCrossRefGoogle Scholar
  49. 49.
    Kaye DM, Mansfield D, Aggarwal A, et al.: Acute effects of CPAP on cardiac sympathetic tone in CHF. Circulation 2001, 103:2336–2338.PubMedGoogle Scholar
  50. 50.
    Naughton MT: Effect of CPAP on intrathoracic and left ventricular transmural pressure in CHF. Circulation 1995, 91:1725–1731.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Matthew T. Naughton
    • 1
  1. 1.Department of MedicineMonash UniversityMelbourneAustralia

Personalised recommendations