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Sleep Apnea, Heart Failure, and Pulmonary Hypertension

  • Prevention of Heart Failure (M St. John Sutton, Section Editor)
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Abstract

Despite the emergence of sleep apnea (SA) as a significant risk factor for heart failure (HF) mortality, data indicate that SA remains under-diagnosed and under-treated. Less well established, though perhaps more emphasized, is the role of sleep apnea in pulmonary hypertension (PH). SA occurs in approximately 50 % of HF patients, and its consequences include intermittent hypoxemia, arousal, and intra-thoracic pressure swings leading to neurohormonal stimulation, oxidative stress and inflammation. While SA is also considered a cause of PH, severe PH due solely to SA is rare. Combining the results of several studies using Swan-Ganz catheters for diagnosis of PH, approximately 10 % of patients with OSA have PH. Effective treatment of SA in HF is associated with improved survival, while treatment of SA in PH is typically associated with modest hemodynamic improvement.

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References

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

  1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2012 update: a report from the American heart association. Circulation. 2012;125:e2–220.

    Article  PubMed  Google Scholar 

  2. •• Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61:391–403. This paper highlights important strategies to minimizing rehospitalization for heart failure, which approahces 30 % within 60 to 90 days after discharge.

    Article  PubMed  Google Scholar 

  3. •• Javaheri S. Sleep-related breathing disorders in heart failure. In: Doulgas L, Mann F, editors. A companion to braunwald's heart disease. Philadelphia: WB Saunders; 2010. p. 471–87. This chapter discusses fundamental pathophysiology of sleep-related breathing disorders.

    Google Scholar 

  4. Herrscher TE, Akre H, Overland B, Sandvik L, Westheim AS. High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. J Card Fail. 2011;17:420–5.

    Article  PubMed  Google Scholar 

  5. Bradley TD, Floras JS. Sleep apnea and heart failure: part I: obstructive sleep apnea. Circulation. 2003;107:1671–8.

    Article  PubMed  Google Scholar 

  6. Garcia-Touchard A, Somers VK, Olson LJ, Caples SM. Central sleep apnea: implications for congestive heart failure. Chest. 2008;133:1495–504.

    Article  PubMed  Google Scholar 

  7. Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, Kubo T, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348:1233–41.

    Article  PubMed  Google Scholar 

  8. •• Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, 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;115:3173–80. This post-hoc analysis of the CANPAP trial demonstrated that patients who responded to CPAP therapy had improved survival, raising the hypothesis that adequate treatment of central sleep apnea can improve survival in heart failure.

    Article  PubMed  Google Scholar 

  9. •• Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT. Sleep apnea testing and outcomes in a large cohort of medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med. 2011;183:539–46. Despite the high prevalence of sleep apnea in heart failure, only 4 % of incident cases of heart failure were referred for sleep studies. Of the small percentage of patients referred and tested, those who were treated demonstrated improved survival.

    Article  PubMed  Google Scholar 

  10. Pickering TG. The clinical significance of diurnal blood pressure variations. Dippers and nondippers. Circulation. 1990;81:700–2.

    Article  PubMed  CAS  Google Scholar 

  11. Bonsignore MR, Marrone O, Insalaco G, Bonsignore G. The cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms. Eur Respir J. 1994;7:786–805.

    Article  PubMed  CAS  Google Scholar 

  12. Javaheri S. Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Int J Cardiol. 2006;106:21–8.

    Article  PubMed  Google Scholar 

  13. Oldenburg O, Lamp B, Topfer V, Faber L, Teschler H, Horstkotte D. Prevalence of sleep-related breathing disorders in ischemic and non-ischemic heart failure. Dtsch Med Wochenschr. 2007;132:661–6.

    Article  PubMed  CAS  Google Scholar 

  14. Zhao ZH, Sullivan C, Liu ZH, Luo Q, Xiong CM, Ni XH, et al. Prevalence and clinical characteristics of sleep apnea in chinese patients with heart failure. Int J Cardiol. 2007;118:122–3.

    Article  PubMed  Google Scholar 

  15. Ferreira S, Marinho A, Patacho M, Santa-Clara E, Carrondo C, Winck J, et al. Prevalence and characteristics of sleep apnoea in patients with stable heart failure: results from a heart failure clinic. BMC Pulm Med. 2010;10:9.

    Article  PubMed  Google Scholar 

  16. •• Bitter T, Faber L, Hering D, Langer C, Horstkotte D, Oldenburg O. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail. 2009;11:602–8. This paper established that the prevalence of sleep apnea in heart failure with preserved ejection fraction patients is probably as high as heart failure with reduced ejection fraction patients.

    Article  PubMed  Google Scholar 

  17. Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007;49:2028–34.

    Article  PubMed  Google Scholar 

  18. Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49:1625–31.

    Article  PubMed  Google Scholar 

  19. Sasayama S, Izumi T, Seino Y, Ueshima K, Asanoi H. Effects of nocturnal oxygen therapy on outcome measures in patients with chronic heart failure and cheyne-stokes respiration. Circ J. 2006;70:1–7.

    Article  PubMed  Google Scholar 

  20. Khayat R, Abraham W, Patt B, Brinkman V, Wannemacher J, Porter K, et al. Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail. 2012;18:534–40.

    Article  PubMed  Google Scholar 

  21. •• Damy T, Margarit L, Noroc A, Bodez D, Guendouz S, Boyer L, et al. Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail. 2012;14:1009–19. This paper demonstrates that in heart failure patients, SDB is associated with worse outcomes but that treatment with PAP therapy improves prognosis.

    Article  PubMed  Google Scholar 

  22. Kasai T, Narui K, Dohi T, Yanagisawa N, Ishiwata S, Ohno M, et al. Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure. Chest. 2008;133:690–6.

    Article  PubMed  Google Scholar 

  23. •• Javaheri S, Shukla R, Wexler L. Association of smoking, sleep apnea, and plasma alkalosis with nocturnal ventricular arrhythmias in men with systolic heart failure. Chest. 2012;141:1449–56. In Veterans with systolic heart failure, multiple regression analysis showed four variables associated with ventricular tachycardia. The authors speculate that effective treatment of sleep disordered breathing and smoking cessation may decrease the incidence of sudden cardiac death.

    Article  PubMed  Google Scholar 

  24. Lafitte S, Pillois X, Reant P, Picard F, Arsac F, Dijos M, et al. Estimation of pulmonary pressures and diagnosis of pulmonary hypertension by doppler echocardiography: a retrospective comparison of routine echocardiography and invasive hemodynamics. J Am Soc Echocardiogr. 2013;26:457–63.

    Article  PubMed  Google Scholar 

  25. Marrone O, Bonsignore MR. Pulmonary haemodynamics in obstructive sleep apnoea. Sleep Med Rev. 2002;6:175–93.

    Article  PubMed  Google Scholar 

  26. Girard C, Fargnoli JM, Fourie P, Maitrasse B, Arvieux CC. Comparison between acute hypoxia-induced and mechanically-induced pulmonary artery hypertension on the hemodynamics, myocardial contractility and regional blood flow in dogs. Fundam Clin Pharmacol. 1995;9:554–61.

    Article  PubMed  CAS  Google Scholar 

  27. Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physiopathol Respir (Nancy). 1972;8:1159–72.

    CAS  Google Scholar 

  28. Lonsdorfer J, Meunier-Carus J, Lampert-Benignus E, Kurtz D, Bapst-Reiter J, Fletto R, et al. hemodynamic and respiratory aspects of the pickwickian syndrome. Bull Physiopathol Respir (Nancy). 1972;8:1181–92.

    CAS  Google Scholar 

  29. Bonsignore MR, Marrone O, Romano S, Pieri D. Time course of right ventricular stroke volume and output in obstructive sleep apneas. Am J Respir Crit Care Med. 1994;149:155–9.

    Article  PubMed  CAS  Google Scholar 

  30. Marrone O, Milone F, Ferrara G, Romano L, Bellia V. Transmural pulmonary artery pressure during cpap in obstructive sleep apnoea syndrome. Eur Respir J Suppl. 1990;11:544s–5.

    PubMed  CAS  Google Scholar 

  31. Marrone O, Bellia V, Ferrara G, Milone F, Romano L, Salvaggio A, et al. Transmural pressure measurements. Importance in the assessment of pulmonary hypertension in obstructive sleep apneas. Chest. 1989;95:338–42.

    Article  PubMed  CAS  Google Scholar 

  32. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest. 1996;109:380–6.

    Article  PubMed  CAS  Google Scholar 

  33. Weitzenblum E, Krieger J, Apprill M, Vallee E, Herhart M, Ratomaharo J, et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis. 1988;138:345–9.

    Article  PubMed  CAS  Google Scholar 

  34. Laks L, Lehrhaft B, Grunstein RR, Sullivan CE. Pulmonary hypertension in obstructive sleep apnoea. Eur Respir J. 1995;8:537–41.

    PubMed  CAS  Google Scholar 

  35. Sanner B, Doberauer C, Konermann M, Sturm A, Zidek W. Pulmonary hypertension in patients with obstructive sleep apnea syndrome. Arch Intern Med. 1997;157:2483–7.

    Article  PubMed  CAS  Google Scholar 

  36. Niijima M, Kimura H, Edo H, Shinozaki T, Kang J, Masuyama S, et al. Manifestation of pulmonary hypertension during REM sleep in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1999;159:1766–72.

    Article  PubMed  CAS  Google Scholar 

  37. Bady E, Achkar A, Pascal S, Orvoen-Frija E, Laaban J-P. Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax. 2000;55:934–9.

    Article  PubMed  CAS  Google Scholar 

  38. Minai OA, Ricaurte B, Kaw R, Hammel J, Mansour M, McCarthy K, et al. Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol. 2009;104:1300–6.

    Article  PubMed  Google Scholar 

  39. •• Dumitrascu R, Tiede H, Eckermann J, Mayer K, Reichenberger F, Ghofrani HA, et al. Sleep apnea in precapillary pulmonary hypertension. Sleep Med. 2013;14:247–51. This work demonstrated a surprising high prevalence of sleep disordered breathing (25 %) in patients with pulmonary hypertension.

    Article  PubMed  Google Scholar 

  40. Minai OA, Pandya CM, Golish JA, Avecillas JF, McCarthy K, Marlow S, et al. Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. Chest. 2007;131:109–17.

    Article  PubMed  Google Scholar 

  41. Schulz R, Baseler G, Ghofrani HA, Grimminger F, Olschewski H, Seeger W. Nocturnal periodic breathing in primary pulmonary hypertension. Eur Respir J: Off J Eur Soc Clin Respir Physiol. 2002;19:658–63.

    Article  CAS  Google Scholar 

  42. Ulrich S, Fischler M, Speich R, Bloch KE. Sleep-related breathing disorders in patients with pulmonary hypertension. Chest. 2008;133:1375–80.

    Article  PubMed  CAS  Google Scholar 

  43. Sajkov D, Wang T, Saunders NA, Bune AJ, McEvoy RD. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:152–8.

    Article  PubMed  Google Scholar 

  44. Arias MA, Garcia-Rio F, Alonso-Fernandez A, Martinez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006;27:1106–13.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Sogol Javaheri declares that he has no conflict of interest.

Shahrokh Javaheri has received financial support through a grant from Philips Respironics, has received financial support for travel to meetings from ResMed Corporation, and has received payment for lectures including service on speakers bureaus from Philips Respironics and ResMed Corporation.

Ali Javaheri declares that he has no conflict of interest.

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

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Authors and Affiliations

  1. Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA

    Sogol Javaheri

  2. Sleepcare Diagnostics, University of Cincinnati, Cincinnati, OH, 45040, USA

    Shahrokh Javaheri

  3. Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA

    Ali Javaheri

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  1. Sogol Javaheri
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Correspondence to Sogol Javaheri.

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Javaheri, S., Javaheri, S. & Javaheri, A. Sleep Apnea, Heart Failure, and Pulmonary Hypertension. Curr Heart Fail Rep 10, 315–320 (2013). https://doi.org/10.1007/s11897-013-0167-3

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