Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

Abstract

Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?—a narrative review

“…CSA is uncommon in the general population compared to OSA (23) but is common in specific subpopulations of patients, including those with heart failure (24,25), stroke (26), and during opioids administration (27). CSA can be also diagnosed in other conditions, or can be defined as idiopathic, according to the International Classification of Sleep Disorders (3rd edition) (ICSD-3) (28).…”

Treating Central Sleep Apnea with One Modification

“…Pulmonary congestion can activate pulmonary C-fibers in the lung parenchyma, which leads to chronic hyperventilation and unstable breathing. It has been shown that CSA worsens the prognosis of patients with systolic dysfunction (2).…”

Central sleep apnea in patients with heart failure: whom to screen and how to treat? – A brief review

“…CSR/B refers to the historical description of periodic breathing (PB) with apnoeas in HF/stroke (5). PB; CSA due to high altitude PB; CSA due to a medication or substance; primary CSA; treatment-emergent CSA (6).…”

“…The recent RCTs show challenging results on current pathophysiology understanding of CSA, and the effects of currently available therapies on clinical outcome are ongoing research (12). Several strategies have been considered for improvement of the ventilation (5).…”

“…Patients should also avoid respiratory depressants such as alcohol, narcotics or anxiolytics. However, these approaches result in a variable and incomplete improvement in CSA/PB (5,32).…”