Advertisement

Sleep Apnea in Heart Failure

  • MuChun Tsai
  • Rami Khayat
Heart Failure (W Tang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Heart Failure

Abstract

Purpose of review

In this review, we discuss the current treatment options for sleep-disordered breathing (SDB) in patients with heart failure (HF). We address the role of positive airway pressure (PAP) devices and other emerging therapies. The review includes discussion of recent trials that reported negative consequences for the PAP devices in patients with heart failure.

Recent findings

Optimal guideline-directed medical therapies of HF and PAP devices have been the mainstay treatments for HF patients with SDB. Recently, randomized controlled trials (RCTs) evaluated the effect of PAP on clinical outcomes in patients with cardiovascular (CV) disease and heart failure and found no benefit in decreasing fatal and non-fatal CV events. The Sleep Apnea Cardiovascular Endpoints (SAVE) trial evaluated continuous positive airway pressure (CPAP) ventilation in patients with CV disease and obstructive sleep apnea (OSA) and did not observe any improvement in CV effect. In patients with HF and central sleep apnea (CSA), adaptive servo-ventilation (ASV) was hypothesized to help HF outcomes, but the Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure (SERVE-HF) trial did not show any mortality benefit. Instead, the trial suggested an increase in all-cause and CV mortality in the treatment arm.

Summary

currently, studies have not shown the use of PAP therapy to improve any risks of CV outcomes or death in HF patients with sleep apnea, but some associations with improvements in symptoms from OSA have been observed.

Keywords

Sleep-disordered breathing Central sleep apnea Obstructive sleep apnea Heart failure Ejection fraction Adaptive servo ventilation Continuous positive airway pressure 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Khayat RN, Jarjoura D, Patt B, Yamokoski T, Abraham WT. In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: report of prevalence and patient characteristics. J Card Fail. 2009;15(9):739–46.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Paulino A, Damy T, Margarit L, Stoica M, Deswarte G, Khouri L, et al. Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure. Arch Cardiovasc Dis. 2009;102(3):169–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Topfer V. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail. 2007;9(3):251–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. 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(4):1101–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J. 2011;32(1):61–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, et al. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015;36(23):1463–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Oldenburg O, Wellmann B, Buchholz A, Bitter T, Fox H, Thiem U, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J. 2016;37(21):1695–703.CrossRefPubMedGoogle Scholar
  9. 9.
    Costanzo MR, Khayat R, Ponikowski P, Augostini R, Stellbrink C, Mianulli M, et al. Mechanisms and clinical consequences of untreated central sleep apnea in heart failure. J Am Coll Cardiol. 2015;65(1):72–84.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Solin P, Bergin P, Richardson M, Kaye DM, Walters EH, Naughton MT. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation. 1999;99(12):1574–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Shepard JW Jr, Pevernagie DA, Stanson AW, Daniels BK, Sheedy PF. Effects of changes in central venous pressure on upper airway size in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1996;153(1):250–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Yumino D, Redolfi S, Ruttanaumpawan P, Su MC, Smith S, Newton GE, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;121(14):1598–605.CrossRefPubMedGoogle Scholar
  13. 13.
    Walsh JT, Andrews R, Starling R, Cowley AJ, Johnston ID, Kinnear WJ. Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. Br Heart J. 1995;73(3):237–41.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tamura A, Kawano Y, Kadota J. Carvedilol reduces the severity of central sleep apnea in chronic heart failure. Circ J. 2009;73(2):295–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Xie A, Skatrud JB, Khayat R, Dempsey JA, Morgan B, Russell D. Cerebrovascular response to carbon dioxide in patients with congestive heart failure. Am J Respir Crit Care Med. 2005;172(3):371–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Skobel EC, Sinha AM, Norra C, Randerath W, Breithardt OA, Breuer C, et al. Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration. Sleep Breath. 2005;9(4):159–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Sinha AM, Skobel EC, Breithardt OA, Norra C, Markus KU, Breuer C, et al. Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol. 2004;44(1):68–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Joosten SA, Hamilton GS, Naughton MT. Impact of weight loss management in OSA. Chest. 2017;152(1):194–203.CrossRefPubMedGoogle Scholar
  19. 19.
    Dixon JB, Schachter LM, O’Brien PE, Jones K, Grima M, Lambert G, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308(11):1142–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370(24):2265–75.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Drager LF, Brunoni AR, Jenner R, Lorenzi-Filho G, Bensenor IM, Lotufo PA. Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials. Thorax. 2015;70(3):258–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841–58.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Iftikhar IH, Kline CE, Youngstedt SD. Effects of exercise training on sleep apnea: a meta-analysis. Lung. 2014;192(1):175–84.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Redolfi S, Bettinzoli M, Venturoli N, Ravanelli M, Pedroni L, Taranto-Montemurro L, et al. Attenuation of obstructive sleep apnea and overnight rostral fluid shift by physical activity. Am J Respir Crit Care Med. 2015;191(7):856–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332(7536):266–70.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Camacho M, Song SA, Tolisano AM. Oral pressure therapy (winx) for obstructive sleep apnea: a meta-analysis updating the systematic review. Sleep Breath. 2016;20(3):1011–2.CrossRefPubMedGoogle Scholar
  27. 27.
    Barnes H, Edwards BA, Joosten SA, Naughton MT, Hamilton GS, Dabscheck E. Positional modification techniques for supine obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2017;36:107–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Szollosi I, Roebuck T, Thompson B, Naughton MT. Lateral sleeping position reduces severity of central sleep apnea/Cheyne-Stokes respiration. Sleep. 2006;29(8):1045–51.CrossRefPubMedGoogle Scholar
  29. 29.
    Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P. Diaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–15.CrossRefPubMedGoogle Scholar
  30. 30.
    Peker Y, Hedner J, Kraiczi H, Loth S. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med. 2000;162(1):81–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.CrossRefPubMedGoogle Scholar
  33. 33.
    Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37(4):967–72.CrossRefPubMedGoogle Scholar
  34. 34.
    Good DC, Henkle JQ, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke. 1996;27(2):252–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Tishler PV, Redline S, Ferrette V, Hans MG, Altose MD. The association of sudden unexpected infant death with obstructive sleep apnea. Am J Respir Crit Care Med. 1996;153(6 Pt 1):1857–63.CrossRefPubMedGoogle Scholar
  36. 36.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.CrossRefPubMedGoogle Scholar
  37. 37.
    Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med. 2004;169(3):361–6.CrossRefPubMedGoogle Scholar
  38. 38.
    •• McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. CPAP for Prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–31. This paper gives details on the SAVE trial was shown not to have any benefits on CPAP therapy in cardiovascular events in patients with OSA.CrossRefPubMedGoogle Scholar
  39. 39.
    Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunstrom E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA Randomized Controlled Trial. Am J Respir Crit Care Med. 2016;194(5):613–20.CrossRefPubMedGoogle Scholar
  40. 40.
    Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005;353(19):2025–33.CrossRefPubMedGoogle Scholar
  41. 41.
    •• Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho MP, Erdmann E, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N Engl J Med. 2015;373(12):1095–105. This paper gives details about the SERVE-HF trial, which did not show any mortality benefit with ASV use in patients with HF and CSA and possible increased mortality in the treatment arm.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    O’Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, et al. Cardiovascular outcomes with minute ventilation-targeted adaptive servo-ventilation therapy in heart failure: the CAT-HF Trial. J Am Coll Cardiol. 2017;69(12):1577–87.CrossRefPubMedGoogle Scholar
  43. 43.
    Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med. 2015;175(8):1278–85.CrossRefPubMedGoogle Scholar
  44. 44.
    Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath. 2017.Google Scholar
  45. 45.
    Abraham WT, Jagielski D, Oldenburg O, Augostini R, Krueger S, Kolodziej A, et al. Phrenic nerve stimulation for the treatment of central sleep apnea. JACC Heart Fail. 2015;3(5):360–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Javaheri S, Somers VK, Campos-Rodriguez F. Reply: Overnight Holter electrocardiography: an opportunity for early sleep apnea diagnosis and treatment. J Am Coll Cardiol. 2017;70(6):810.CrossRefPubMedGoogle Scholar
  47. 47.
    Nakao YM, Ueshima K, Yasuno S, Sasayama S. Effects of nocturnal oxygen therapy in patients with chronic heart failure and central sleep apnea: CHF-HOT study. Heart Vessel. 2016;31(2):165–72.CrossRefGoogle Scholar
  48. 48.
    Germany R. Non-mask-based therapies for central sleep apnea in patients with heart failure. Sleep Med Clin. 2017;12(2):255–64.CrossRefPubMedGoogle Scholar
  49. 49.
    Javaheri S. Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. Am J Respir Crit Care Med. 2006;173(2):234–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Eckert DJ, Owens RL, Kehlmann GB, Wellman A, Rahangdale S, Yim-Yeh S, et al. Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond). 2011;120(12):505–14.CrossRefGoogle Scholar
  51. 51.
    Carter SG, Berger MS, Carberry JC, Bilston LE, Butler JE, Tong BK, et al. Zopiclone increases the arousal threshold without impairing genioglossus activity in obstructive sleep apnea. Sleep. 2016;39(4):757–66.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Eckert DJ, Malhotra A, Wellman A, White DP. Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold. Sleep. 2014;37(4):811–9.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Carberry JC, Amatoury J, Eckert DJ. Personalized management approach for OSA. Chest. 2017.Google Scholar
  54. 54.
    Biberdorf DJ, Steens R, Millar TW, Kryger MH. Benzodiazepines in congestive heart failure: effects of temazepam on arousability and Cheyne-Stokes respiration. Sleep. 1993;16(6):529–38.CrossRefPubMedGoogle Scholar
  55. 55.
    Guilleminault C, Clerk A, Labanowski M, Simmons J, Stoohs R. Cardiac failure and benzodiazepines. Sleep. 1993;16(6):524–8.PubMedGoogle Scholar
  56. 56.
    Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. JAMA. 2017;318(2):156–66.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017;49(1).Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Division of Pulmonary Critical Care and SleepThe Ohio State UniversityColumbusUSA
  2. 2.The Sleep Heart ProgramThe Ohio State UniversityColumbusUSA

Personalised recommendations