Sleep in Heart Failure
Section snippets
Heart Failure: Prevalence, Incidence, and Pathogenesis
Heart failure is defined as the inability to maintain cardiac output for a given task. Symptoms include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Four classes of HF have been identified: (a) high risk no symptoms, (b) structural heart disease but asymptomatic, (c) structural heart disease and previous or current symptoms, and (d) refractory symptoms requiring special intervention.1
The prevalence of HF in a westernized community aged more than 45 years is estimated to
Pathogenesis Linking OSA with HF
Strong epidemiological links exist between snoring, OSA, and HF. Children who have OSA have thicker ventricular walls compared with nonsnoring controls.16 More than 55% of patients with OSA have diastolic dysfunction.17 Large community studies have identified significant relationships between OSA and self-reported HF.18
There are 4 key pathophysiologic features of OSA that could adversely affect function of the left ventricle:(a) generation of exaggerated negative intrathoracic pressure, (b)
Pathogenesis Linking CSA-CSR with HF
The prevalence of sleep disordered breathing in patients with HF is strikingly high, and depending upon definitions, CSA-CSR ranges from 30% to 50% and OSA ranges from 20% to 40%.40, 41, 42
Patients with HF with OSA or CSA-CSR present with significantly higher sympathetic nerve activity while awake, as compared with HF patients and no sleep disordered breathing.43 The negative effects of sleep disordered breathing may cause a more dramatic effect in patients with HF. For instance, the
Treatment of OSA in HF
The precise treatment for OSA depends on its severity, duration, and cause in addition to the patient's age. Obstructive sleep apnea occurs in all age groups with differing contributing factors and thus treatment options. In children, anatomic factors predominate (tonsillar hypertrophy, retrognathia). In adults, weight gain, alcohol, and sleep deprivation predominate causation. In the elderly, complications of underlying medical conditions or their treatment and ageing-related hypotonia of
Treatment of CSA-CSR in HF
Cheyne-Stokes respiration is thought to be a consequence of the failing heart. In accordance to this view, CSA-CSR was abolished in most of the patients with HF after heart transplant.82 In addition, cardiac resynchronization in patients with CHF associated with conduction disturbances83 was able to significantly ameliorate CSA-CSR in conjunction with a significant improvement in heart function.
The effects of drug therapies targeting the failing heart on CSA-CSR are controversial. Solin et al41
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Cited by (50)
Obstructive sleep apnea and its cardiovascular consequences
2021, Revista Medica Clinica Las CondesTailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial
2016, International Journal of Nursing StudiesCitation Excerpt :Sleep disturbance is a common symptom experienced by 45–79% patients with heart failure and interferes with their physical function and results in decreased quality of life (Chen et al., 2009; Moradi et al., 2014; Suna et al., 2014). More than half of patients with heart failure develop sleep-disordered breathing including central sleep apnea and obstructive sleep apnea, which are associated with fragmentation of sleep, excessive daytime sleepiness, and fatigue and result in decreased quality of life and increased mortality (Bitter et al., 2012; Naughton and Lorenzi-Filho, 2009; Skobel et al., 2005). Oldenburg et al. (2007) reported that sleep-disordered breathing was present in 76% of patients with heart failure, 40% of patients had central sleep apnea and 36% had obstructive sleep apnea.
Home Ventilation Therapy in Obstructive Sleep Apnea–Hypopnea Syndrome
2014, Archivos de BronconeumologiaCitation Excerpt :In many, there is an underlying cardiac cause, primarily heart failure. There is growing scientific evidence to suggest that central apnea syndrome (CAS) with Cheyne–Stokes respiration may be an indicator for higher morbidity and mortality, and effective treatment can improve the clinical course of these patients.61–63 Some studies have shown that CPAP reduces AHI, improves left ventricular ejection fraction, and reduces sympathetic activity in heart failure.64–66
Usefulness of oximetry for sleep apnea screening in frail hospitalized elderly
2014, Journal of the American Medical Directors AssociationCitation Excerpt :Indeed, most of the included individuals exhibited cardiovascular diseases in our hospitalized sample,28 and this probably contributed to the high prevalence we found. It has been demonstrated that two-thirds of patients with cardiac failure suffered from central or OSA,26,29 and that sleep apnea prevalence is up to 60% to 80% in resistant hypertension. In Teramoto et al's2 and Ancoli-Israël et al's25 studies, 80% and 53%, respectively, of the participants were free of cardiovascular disease.
Cheyne-stokes respiration
2014, Sleep Medicine ClinicsCitation Excerpt :The SRBD group can be further categorized into 2 groups: one with predominantly obstructive sleep apnea (OSA), the second with predominantly CSA-CSR. OSA is considered a cause of HF, whereas CSA-CSR is considered a result of HF.6 HF is a complex disorder caused by a broad range of conditions, an understanding of which is required to understand the pathogenesis and management of CSA-CSR.