Impact of Obstructive Sleep Apnoea on Heart Failure with Preserved Ejection Fraction

Abstract

Obstructive sleep apnoea, even when treated appropriately, may worsen long-term cardiac function and outcomes in patients who have heart failure with preserved ejection fraction.

Effects of continuous positive airway pressure therapy on left ventricular diastolic function: a randomised, sham-controlled clinical trial

“…Observational studies have suggested that OSA contributes to the development of LV diastolic dysfunction and subsequent heart failure, even in patients with preserved ejection fraction [3,4,11]. Although several studies have suggested a role for OSA as an independent risk factor for the development of diastolic dysfunction, there have been inconsistent data, depending on the methodological approaches used to detect early diastolic dysfunction and the selection of the study populations [13,25,26].…”

“…Obstructive sleep apnoea (OSA) is a common chronic sleep disorder that is characterised by periodic reduction or cessation of breathing due to narrowing of the upper airways during sleep [1]. OSA is thought to be related to heart failure [2][3][4], as well as hypertension [5,6], myocardial infarction [7] and arrhythmia [8], and exhibits episodic hypoxaemia, nocturnal sympathetic nervous system activation, elevated blood pressure (BP), and markers of oxidative stress, inflammation and hypercoagulability [9,10].…”

“…Left ventricular (LV) diastolic dysfunction is often observed in patients with OSA, and is accompanied by common comorbidities, such as hypertension, obesity and diabetes, and consequent arterial stiffness and LV hypertrophy [11][12][13][14]. OSA contributes to the development of LV diastolic dysfunction and subsequent heart failure, even in patients with preserved ejection fraction [3,4,11]. Recent studies have suggested partial reversal of LV diastolic dysfunction after continuous positive airway pressure (CPAP) therapy through improved myocardial oxygenation, diminished LV pressure overload and sympathetic activation [13,15,16].…”

Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction

“…In 109 consecutive patients on HF medical therapy with moderate to severe sleep-disordered breathing, non-invasive positive pressure ventilation (NIPPV) has been shown to provide an improvement in right heart function and pulmonary function as well as a reduction in all-cause mortality [112]. However, in a study of 101 patients newly diagnosed with HFpEF on hospital admission, 58 patients underwent screening for sleep apnea which confirmed a diagnosis in 39 patients [113]. These 39 patients all received non-invasive positive pressure ventilation.…”

Obstructive Sleep Apnea Syndrome in Congestive Heart Failure: Cardiologist Perspective

“…Однако при серийном измерении уровня BNP через 6, 12 и 36 мес. выявлены значимые различия (р<0,05): показатели у пациентов с обструктивным апноэ достоверно превышали таковые в группе сравнения [16]. Таким образом, несмот ря на проводимую адекватную CPAP-терапию, пациенты с диастолической сердечной недостаточностью и СОАС имеют более высокие показатели миокардиального стресса, чем пациенты без нарушений дыхания во сне.…”