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Sleep Disordered Breathing in Patients with Heart Failure: Pathophysiology and Management

  • Valvular, Myocardial, Pericardial, and Cardiopulmonary Diseases (Patrick O’Gara and Akshay Desai, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Sleep disordered breathing (SDB) is common in heart failure patients across the range of ejection fractions and is associated with adverse prognosis. Although effective pharmacologic and device-based treatment of heart failure may reduce the frequency or severity of SDB, heart failure treatment alone may not be adequate to restore normal breathing during sleep. Continuous positive airway pressure (CPAP) is the major treatment for SDB in heart failure, especially if obstructive rather than central sleep apnea (CSA) predominates. Adequate suppression of CSA by PAP is associated with a heart transplant-free survival benefit, although randomized trials are ongoing. Bilevel PAP (BPAP) may be as effective as CPAP in treating SDB and may be preferable over CPAP in patients who experience expiratory pressure discomfort. Adaptive (or auto) servo-ventilation (ASV), which adjusts the PAP depending on the patient’s airflow or tidal volume, may be useful in congestive heart failure patients if CPAP is ineffective. Other therapies that have been proposed for SDB in congestive heart failure include nocturnal oxygen, CO2 administration (by adding dead space), theophylline, and acetazolamide; most of which have not been systematically studied in outcome-based prospective randomized trials.

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Disclosure

B. Sharma is supported by a National Institutes of Health 5T32HL007901 training grant. D. McSharry is funded by an American Heart Association post-doctoral fellowship. A. Malhotra has consulting and/or research income from the National Institutes of Health, American Heart Association, Philips, Apnex, Apnicure, SGS, SHC, Ethicon, Medtronic, Pfizer, Merck, Sepracor, and Cephalon. He is Principal Investigator on NIH R01 HL085188, AHA 0840159 N, NIH R01 HL090897, NIH K24 HL 093218, NIH P01 HL 095491, and NIH R01-AG035117.

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  1. Harvard Medical School, Brigham and Women’s Hospital, 221 Longwood Avenue, BLI 035M, Boston, MA, 02115, USA

    Bhavneesh Sharma, David McSharry MD & Atul Malhotra MD

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  1. Bhavneesh Sharma
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  2. David McSharry MD
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Correspondence to Bhavneesh Sharma.

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Sharma, B., McSharry, D. & Malhotra, A. Sleep Disordered Breathing in Patients with Heart Failure: Pathophysiology and Management. Curr Treat Options Cardio Med 13, 506–516 (2011). https://doi.org/10.1007/s11936-011-0145-6

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