Mechanisms and Clinical Consequences of Untreated Central Sleep Apnea in Heart Failure

• Published in: Journal of the American College of Cardiology Vol. 65; no. 1; pp. 72 - 84
• Main Authors: Costanzo, Maria Rosa, MD, Khayat, Rami, MD, Ponikowski, Piotr, MD, Augostini, Ralph, MD, Stellbrink, Christoph, MD, Mianulli, Marcus, BS, Abraham, William T., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 06.01.2015; Elsevier Limited
• Subjects: Airway management; apnea-hypopnea index; Brain - blood supply; Carbon dioxide; Cardiac Output; Cardiology; Cardiovascular; Comorbidity; continuous positive airway pressure; Disease Progression; Electric Stimulation Therapy; Endothelium, Vascular - physiopathology; Heart failure; Heart Failure - epidemiology; Humans; Hyperventilation - physiopathology; Hypoxia; Internal Medicine; Metabolism; Mortality; Oxidative Stress - physiology; Pathogenesis; Patients; Phrenic Nerve - physiology; Polysomnography; Quality of Life; reactive oxygen species; Regional Blood Flow; reoxygenation; Respiration; Risk Factors; Severity of Illness Index; Sleep apnea; Sleep Apnea, Central - epidemiology; Sleep Apnea, Central - physiopathology; Sleep disorders; Theophylline - therapeutic use; Vasodilator Agents - therapeutic use; Ventilation; obstructive sleep apnea; hypoxia; heart failure; AHI; CPAP; ASV; CRT; cardiac resynchronization therapy; left ventricular ejection fraction; LVEF; nuclear factor-kappa B; reoxygenation; apnea-hypopnea index; continuous positive airway pressure; CSA; NF-κB; central sleep apnea; reactive oxygen species; ROS; OSA; adaptive pressure support servo-ventilation; HF
• ISSN: 0735-1097; 1558-3597
• 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.