Management of Sleep Disordered Breathing in Patients with Heart Failure

  • Connor P. Oates
  • Manjula Ananthram
  • Stephen S. Gottlieb
Pharmacologic Therapy (W.H.W. Tang, Section Editor)
First Online:
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Part of the following topical collections:
  1. Topical Collection on Pharmacologic Therapy

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.

Keywords

Heart failure Treatment of sleep disordered breathing Obstructive sleep apnea Central sleep apnea ASV 
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Notes

Compliance with Ethical Standards

Conflict of Interest

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.

Human and Animal Rights and Informed Consent

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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Connor P. Oates
    • 1
  • Manjula Ananthram
    • 1
  • Stephen S. Gottlieb
    • 1
  1. 1.School of MedicineUniversity of MarylandBaltimoreUSA

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