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Sleep-disordered breathing in acute decompensated heart failure

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Abstract

Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is highly prevalent and frequently unrecognized in patients with chronic heart failure (HF). Untreated SDB may worsen acute decompensation of HF and delay recovery by increasing vascular inflammation and oxidative stress, impeding control of the blood pressure, and promoting arrhythmias. Untreated OSA doubles the risk for developing HF, and patients with HF who develop OSA are thought to have a worse prognosis than patients with HF alone. Similar to the findings in the general population, treatment of OSA appears to reduce cardiovascular morbidity and mortality in HF. The presence of CSA is associated with increased mortality in HF patients. Efficacious suppression of central sleep apnea with continuous positive airway pressure therapy may reduce mortality in HF.

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References and Recommended Reading

  1. 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.

    PubMed  CAS  Google Scholar 

  2. Javaheri S, Parker TJ, Liming JD, et al.: Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 1998, 97:2154–2159.

    PubMed  CAS  Google Scholar 

  3. 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.

    PubMed  CAS  Google Scholar 

  4. Oldenburg O, Lamp B, Faber L, et al.: 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, 9:251–257.

    Article  PubMed  Google Scholar 

  5. Arzt M, Young T, Finn L, et al.: Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006, 166:1716–1722.

    Article  PubMed  Google Scholar 

  6. Wang H, Parker JD, Newton GE, et al.: Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 2007, 49:1625–1631.

    Article  PubMed  Google Scholar 

  7. MacDonald M, Fang J, Pittman SD, et al.: The current prevalence of sleep disordered breathing in congestive heart failure patients treated with beta-blockers. J Clin Sleep Med 2008, 4:38.

    PubMed  Google Scholar 

  8. Lanfranchi PA, Braghiroli A, Bosimini E, et al.: Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation 1999, 99:1435–1440.

    PubMed  CAS  Google Scholar 

  9. Sin DD, Logan AG, Fitzgerald FS, Liu PP, Bradley TD: Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation 2000, 102:61–66.

    PubMed  CAS  Google Scholar 

  10. Arzt M, Floras JS, Logan AG, et al.: Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure. A post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP). Circulation 2007, 115:3173–3180.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  CAS  Google Scholar 

  12. Yaggi HK, Concato J, Kernan WN, et al.: Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005, 353:2034–2041.

    Article  PubMed  CAS  Google Scholar 

  13. Peker Y, Kraiczi H, Hedner J, et al.: An independent association between obstructive sleep apnea and coronary artery disease. Eur Respir J 1999, 13:179–184.

    Article  Google Scholar 

  14. Marshall NS, Wong KK, Liu PY, et al.: Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008, 31:1079–1085.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Young T, Skatrud J, Peppard PE: Risk factors for obstructive sleep apnea in adults. JAMA. 2004, 291:2013–2016.

    Article  PubMed  CAS  Google Scholar 

  17. Chan J, Sanderson J, Chan W, et al.: Prevalence of sleep-disordered breathing in diastolic heart failure. Chest 1997, 111:1488–1493.

    Article  PubMed  CAS  Google Scholar 

  18. Dark DS, Pingleton SK, Kerby GR, et al.: Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy. Chest 1987, 91:833–836.

    Article  PubMed  CAS  Google Scholar 

  19. Tremel F, Pépin JL, Veale D, et al.: High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months. Eur Heart J 1999, 20:1201–1209.

    Article  PubMed  CAS  Google Scholar 

  20. Padeletti M, Green P, Mooney AM, et al.: Sleep disordered breathing in patients with acutely decompensated heart failure. Sleep Med 2009, 10:353–360.

    Article  PubMed  Google Scholar 

  21. Sériès F, Kimoff RJ, Morrison D, et al.: Prospective evaluation of nocturnal oximetry for detection of sleep-related breathing disturbances in patients with chronic heart failure. Chest 2005, 127:1507–1514.

    Article  PubMed  Google Scholar 

  22. Marin JM, Carrizo SJ, Vicente E, Agusti AG: Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005, 365:1046–1053.

    PubMed  Google Scholar 

  23. Naughton MT, Benard DC, Liu PP, et al.: Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 1995, 152:473–479.

    PubMed  CAS  Google Scholar 

  24. Leung RS, Bowman ME, Diep TM, et al.: Influence of Cheyne-Stokes respiration on ventricular response to atrial fibrillation in heart failure. J Appl Physiol 2005, 99:1689–1696.

    Article  PubMed  Google Scholar 

  25. Spaak J, Egri ZJ, Kubo T, et al.: Muscle sympathetic nerve activity during wakefulness in heart failure patients with and without sleep apnea. Hypertension 2005, 46:1327–1332.

    Article  PubMed  CAS  Google Scholar 

  26. Bradley TD, Logan AG, Kimoff RJ, et al.: Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005, 353:2025–2033.

    Article  PubMed  CAS  Google Scholar 

  27. Crossover Comparison of Treatment With Continuous Positive Airway Pressure and Treatment With Adaptive Servo Ventilation (SOMNOventCR) in Patients With Underlying Heart Disease, Combined Obstructive Sleep Apnea and Cheyne-Stokes Respiration. ClinicalTrials.gov identifier: NCT00811668. Available at http://clinicaltrials.gov/ct2/show/NCT00811668?term=NCT00811668&rank=1. Accessed July 2009.

  28. Naughton MT, Rahman MA, Hara K, et al.: Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 1995, 91:1725–1731.

    PubMed  CAS  Google Scholar 

  29. Redolfi S, Yumino D, Ruttanaumpawan P, et al.: Relationship between overnight rostral fluid shift and Obstructive Sleep Apnea in nonobese men. Am J Respir Crit Care Med 2009, 179:241–246.

    Article  PubMed  Google Scholar 

  30. Kato M, Roberts-Thomson P, Phillips BG, et al.: Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive sleep apnea. Circulation 2000, 102:2607–2610.

    PubMed  CAS  Google Scholar 

  31. Ip MS, Tse HF, Lam B, et al.: Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004, 169:348–353.

    Article  PubMed  Google Scholar 

  32. Jelic S, Padeletti M, Kawut SM, et al.: Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 2008, 117:2270–2278.

    Article  PubMed  CAS  Google Scholar 

  33. Takemoto M, Sun J, Hiroki J, et al.: Rho-kinase mediates hypoxia-induced downregulation of endothelial nitric oxide synthase. Circulation 2002, 106:57–62.

    Article  PubMed  CAS  Google Scholar 

  34. Antoniades C, Shirodaria C, Warrick N, et al.: 5-Methyltetrahydrofolate rapidly improves endothelial function and decreases superoxide production in human vessels: effects on vascular tetrahydrobiopterin availability and endothelial nitric oxide synthase coupling. Circulation 2006, 114:1193–1201.

    Article  PubMed  CAS  Google Scholar 

  35. Ryan S, Taylor CT, McNicholas WT: Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 2005, 112:2660–2667.

    Article  PubMed  CAS  Google Scholar 

  36. Greenberg H, Ye X, Wilson D, et al.: Chronic intermittent hypoxia activates nuclear factor-kappaB in cardiovascular tissues in vivo. Biochem Biophys Res Commun 2006, 343:591–596.

    Article  PubMed  CAS  Google Scholar 

  37. Minoguchi K, Yokoe T, Tazaki T, et al.: Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 2005, 172:625–630.

    Article  PubMed  Google Scholar 

  38. Dyugovskaya L, Lavie P, Lavie L: Lymphocyte activation as a possible measure of atherosclerotic risk in patients with sleep apnea. Ann N Y Acad Sci 2005, 1051:340–350.

    Article  PubMed  CAS  Google Scholar 

  39. Svatikova A, Wolk R, Shamsuzzaman AS, et al.: Serum amyloid a in obstructive sleep apnea. Circulation 2003, 108:1451–1454.

    Article  PubMed  CAS  Google Scholar 

  40. Meier-Ewert HK, Ridker PM, Rifai N, et al.: Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004, 43:678–683.

    Article  PubMed  CAS  Google Scholar 

  41. Irwin M, Wang M, Campomayor CO, et al.: Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006, 166:1756–1762.

    Article  PubMed  CAS  Google Scholar 

  42. Shearer WT, Reuben JM, Mullington JM, et al.: Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. J Allergy Clin Immunol 2001, 107:165–170.

    Article  PubMed  CAS  Google Scholar 

  43. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al.: Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002, 105:2462–2464.

    Article  PubMed  CAS  Google Scholar 

  44. Tilkian AG, Guilleminault C, Schroeder JS, et al.: Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep. Ann Intern Med 1976, 85:714–719.

    PubMed  CAS  Google Scholar 

  45. Calhoun DA, Jones D, Textor S, et al.: American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008, 117:e510–e526.

    Article  PubMed  Google Scholar 

  46. Mehra R, Benjamin EJ, Shahar E, et al.: Sleep Heart Health Study. Association of nocturnal arrhythmias with sleepdisordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006, 173:910–916.

    Article  PubMed  Google Scholar 

  47. Gami AS, Hodge DO, Herges RM, et al.: Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007, 49:565–571.

    Article  PubMed  Google Scholar 

  48. Kanagala R, Murali NS, Friedman PA, et al.: Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 2003, 107:2589–2594.

    PubMed  Google Scholar 

  49. Gami AS, Howard DE, Olson EJ, Somers VK: Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005, 352:1206–1214.

    Article  PubMed  CAS  Google Scholar 

  50. Cohen MC, Rohtla KM, Lavery CE, et al.: Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 1997, 79:1512–1516.

    Article  PubMed  CAS  Google Scholar 

  51. Solin P, Bergin P, Richardson M, et al.: Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 1999, 99:1574–1579.

    PubMed  CAS  Google Scholar 

  52. Tamura A, Kawano Y, Naono S, et al.: Relationship between beta-blocker treatment and the severity of central sleep apnea in chronic heart failure. Chest 2007, 131:130–135.

    Article  PubMed  CAS  Google Scholar 

  53. Walsh JT, Andrews R, Starling R, et al.: Effects of captopril and oxygen on sleep apnea in patients with mild to moderate congestive cardiac failure. Br Heart J 1995, 73:237–241.

    Article  PubMed  CAS  Google Scholar 

  54. Padeletti M, Henriquez A, Mancini DM, Basner RC: Persistence of Cheyne-Stokes breathing after left ventricular assist device implantation in patients with acutely decompensated end-stage heart failure. J Heart Lung Transplant 2007, 26:742–744.

    Article  PubMed  Google Scholar 

  55. Vazir A, Hastings PC, Morrell MJ, et al.: Resolution of central sleep apnoea following implantation of a left ventricular assist device. Int J Cardiol 2008 Aug 25.

  56. Braver HM, Brandes WC, Kubiet MA, et al.: Effect of cardiac transplantation on Cheyne-Stokes respiration occurring during sleep. Am J Cardiol 1995, 76:632–634.

    Article  PubMed  CAS  Google Scholar 

  57. Mansfield DR, Solin P, Roebuck T, et al.: The effect of successful heart transplant treatment of heart failure on central sleep apnea. Chest 2003, 124:1675–1681.

    Article  PubMed  Google Scholar 

  58. Javaheri S, Abraham WT, Brown C, et al.: Prevalence of obstructive sleep apnoea and periodic limb movement in 45 subjects with heart transplantation. Eur Heart J 2004, 25:260–266.

    Article  PubMed  Google Scholar 

  59. Javaheri, Nkere UU, Hall MC, Corris PA: Sleep apnoea/hypopnoea syndrome: a potential cause of graft failure following heart transplantation. Eur J Cardiothorac Surg 1998, 13:203–205.

    Article  Google Scholar 

  60. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al.: Ambulatory blood pressure following therapeutic and subtherapeutic nasal CPAP for OSA: a randomised controlled parallel trial. Lancet 2002, 359:204–210.

    Article  PubMed  Google Scholar 

  61. Kaneko Y, Floras JS, Usui K, et al.: Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003, 348:1233–1241.

    PubMed  Google Scholar 

  62. Philippe C, Stoïca-Herman M, Drouot X, et al.: Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period. Heart 2006, 92:337–342.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Sanja Jelic.

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Jelic, S., Le Jemtel, T.H. Sleep-disordered breathing in acute decompensated heart failure. Curr Heart Fail Rep 6, 169–175 (2009). https://doi.org/10.1007/s11897-009-0024-6

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