Sleep disordered breathing in heart failure
- Atul Malhotra, MD
Atul Malhotra, MD
- Kenneth M Moser Professor, Department of Medicine
- University of California, San Diego
- James C Fang, MD
James C Fang, MD
- Professor of Medicine
- University of Utah
Sleep disordered breathing (SDB) is common and under-diagnosed in patients with heart failure across a range of ejection fractions and New York Heart Association (NYHA) classes. The most common forms of SDB in heart failure patients are obstructive sleep apnea and central sleep apnea with Cheynes-Stokes breathing. SDB is important to recognize because it is associated with adverse cardiovascular outcomes and mortality, and because accumulating evidence suggests that treatment of SDB can improve heart failure-related outcomes and quality of life.
In this review, the prevalence, risk factors, pathogenesis, clinical manifestations, diagnosis, and treatment of SDB in patients with heart failure are discussed. In addition, the impact of treatment on heart failure-related outcomes is reviewed. The treatment of SDB in more general populations is discussed separately. (See "Management of obstructive sleep apnea in adults" and "Central sleep apnea: Treatment".)
OBSTRUCTIVE VERSUS CENTRAL SLEEP APNEA
Two types of sleep disordered breathing (SDB) are common among patients with heart failure: obstructive sleep apnea (OSA) and central sleep apnea with Cheyne-Stokes breathing (CSA-CSB):
●OSA is characterized by reductions or cessations of airflow during sleep, despite ongoing respiratory effort. It is due to upper airway obstruction. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults", section on 'Diagnosis'.)
●CSB is characterized by cyclic crescendo-decrescendo respiratory effort and airflow during wakefulness or sleep, without upper airway obstruction. When the decrescendo effort is accompanied by apnea during sleep, it is considered a type of central sleep apnea syndrome. (See "Sleep related breathing disorders in adults: Definitions", section on 'Cheynes-Stokes breathing' and "Central sleep apnea: Risk factors, clinical presentation, and diagnosis", section on 'Diagnostic criteria'.)
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- OBSTRUCTIVE VERSUS CENTRAL SLEEP APNEA
- PREVALENCE AND RISK FACTORS
- PROGNOSTIC IMPLICATIONS
- CLINICAL FEATURES
- WHO SHOULD BE TESTED?
- Heart failure therapy
- Positive airway pressure therapy
- - Heart failure outcomes
- - Arrhythmias
- - Overall survival
- Weight loss and exercise
- Other therapies
- - Nocturnal oxygen
- - Theophylline
- SUMMARY AND RECOMMENDATIONS