Sleep apnoea and heart failure

Abstract

Heart Failure (HF) and Sleep-Disordered-Breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades. Obstructive Sleep Apnea (OSA) may result in myocardial damage, due to intermittent hypoxia increased sympathetic activity and transmural pressures, low-grade vascular inflammation and oxidative stress. On the other hand, central sleep apnoea and Cheyne-Stokes respiration (CSA-CSR) occurs in HF, irrespective of ejection fraction either reduced (HFrEF), preserved (HFpEF) or mildly reduced (HFmrEF). The pathophysiology of CSA-CSR relies on several mechanisms leading to hyperventilation, breathing cessation and periodic breathing. Pharyngeal collapse may result at least in part from fluid accumulation in the neck, owing to daytime fluid retention and overnight rostral fluid shift from the legs. Although both OSA and CSA-CSR occur in HF, the symptoms are less suggestive than in typical (non-HF related) OSA. Overnight monitoring is mandatory for a proper diagnosis, with accurate measurement and scoring of central and obstructive events, since the management will be different depending on whether the sleep apnea in HF is predominantly OSA or CSA-CSR. SDB in HF are associated with worse prognosis, including higher mortality than in patients with HF but without SDB. However, there is currently no evidence that treating SDB improves clinically important outcomes in patients with HF, such as cardiovascular morbidity and mortality.

Heart Failure with Preserved Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2 Diabetes

“…This approach would expand their indications beyond current ones, including glucose, lipids, uric acid, blood pressure, body weight control, and chronic HF, and kidney disease prevention [ 32 ]. This hypothesis finds further support in the previously mentioned EMPEROR-Preserved trial because of the close association between OSA and HFpEF [ 7 , 33 ]. Indeed, OSA is associated with an increased risk of hospital admission for HFpEF [ 34 ].…”

Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea

“…OSA affects CHF by compromising filling and emptying of the left ventricle by intrathoracic pressure variation and by sympathetic stimulation. 60 The increased venous and extravascular fluid volume leads to SDB disorder which includes OSA. 61 Current recommendation suggests CPAP therapy improves CHF in patients with OSA diagnoses.…”

Serum Cytokines as Biomarkers in Heart Failure with Preserved Ejection Fraction and Sleep Apnea: A Prospective Cohort Study

“…Increased fluid accumulation in the neck results in narrowing of the pharynx and increasing its propensity to collapse during sleep. This represents a possible mechanism by which HFpEF can lead to increased risk of OSA [ 14 ].…”