Mechanisms and clinical consequences of untreated central sleep apnea in heart failure

J Am Coll Cardiol. 2015 Jan 6;65(1):72-84. doi: 10.1016/j.jacc.2014.10.025.

Abstract

Central sleep apnea (CSA) is a highly prevalent, though often unrecognized, comorbidity in patients with heart failure (HF). Data from HF population studies suggest that it may present in 30% to 50% of HF patients. CSA is recognized as an important contributor to the progression of HF and to HF-related morbidity and mortality. Over the past 2 decades, an expanding body of research has begun to shed light on the pathophysiologic mechanisms of CSA. Armed with this growing knowledge base, the sleep, respiratory, and cardiovascular research communities have been working to identify ways to treat CSA in HF with the ultimate goal of improving patient quality of life and clinical outcomes. In this paper, we examine the current state of knowledge about the mechanisms of CSA in HF and review emerging therapies for this disorder.

Keywords: apnea-hypopnea index; continuous positive airway pressure; hypoxia; reactive oxygen species; reoxygenation.

Publication types

  • Review

MeSH terms

  • Brain / blood supply
  • Cardiac Output
  • Comorbidity
  • Disease Progression
  • Electric Stimulation Therapy
  • Endothelium, Vascular / physiopathology
  • Heart Failure / epidemiology*
  • Humans
  • Hyperventilation / physiopathology
  • Oxidative Stress / physiology
  • Phrenic Nerve / physiology
  • Polysomnography
  • Quality of Life
  • Regional Blood Flow
  • Risk Factors
  • Severity of Illness Index
  • Sleep Apnea, Central / epidemiology
  • Sleep Apnea, Central / physiopathology*
  • Theophylline / therapeutic use
  • Vasodilator Agents / therapeutic use

Substances

  • Vasodilator Agents
  • Theophylline