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Sleep apnea and heart failure

Heart failure is a growing problem worldwide that rises with age, and is estimated to affect 6-10% of people aged over 65.1

Up to 73% of patients with stable heart failure experience sleep-disordered breathing (SDB),2 with Cheyne-Stokes respiration (CSR), obstructive sleep apnea (OSA) or central sleep apnea (CSA).

What is CSR?

CSR occurs when periods of hyperventilation and hypoventilation, in a waxing and waning breathing pattern, alternate with periods of central hypopnea and apnoea.

CSR has been found to be a highly prevalent form of SDB in patients with severe left ventricular dysfunction.3

csr

What are the consequences of CSR?

Nocturnal CSA/CSR is associated with increased mortality4 in CHF patients.

CSR may accelerate the progression of heart failure by causing:

  • repetitive hypoxia
  • increased afterload
  • increased sympathetic activity5
  • oscillations in heart rate and blood pressure6.

Fragmented sleep resulting from CSR also causes fatigue which impacts quality of life.6

References

1

Joseph et al. Acute Decompensated Heart Failure Tex Heart Inst J. 2009

2

Ferreira S, et al. Prevalence and characteristics of sleep apnoea in patients with stable heart failure: Results from a heart failure clinic. BMC Pulm Med.2010, 10:9

3

Lanfranchi PA, et al. Central sleep apnea in left ventricular dysfunction. Prevalence and implications for arrhythmic risk. Circulation 2003, 107: 727.

4

Javaheri S, et al. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007, 49(20):2028-34.

5

Garcia-Touchard A, et al. Central sleep apnea: implications for congestive heart failure. Chest. 2008, 133(6):1495-504.

6

Bradley TD et al Sleep Apnea and Heart Failure Part II: Central Sleep Apnea Circulation 2003;107:1822-1826