Central sleep apnea: implications for congestive heart failure.
Congestive heart failure (HF), an exceedingly common and costly disease, is frequently seen in association with central sleep apnea (CSA), which often manifests as a periodic breathing rhythm referred to as Cheyne-Stokes respiration. CSA has historically been considered to be a marker of heart disease, since improvement in cardiac status is often associated with the attenuation of CSA. However, this mirroring of HF and CSA may suggest bidirectional importance to their relationship. In fact, observational data suggest that CSA, associated with repetitive oxyhemoglobin desaturations and surges in sympathetic neural activity, may be of pathophysiologic significance in HF outcomes. In light of the disappointing results from the first large trial assessing therapy with continuous positive airway pressure in patients with CSA and HF, further large-scale interventional trials will be needed to assess the role, if any, of CSA treatment on the outcomes of patients with HF. This review will discuss epidemiologic, pathophysiologic, diagnostic, and therapeutic considerations of CSA in the setting of HF.
Garcia-Touchard
Arturo
A
Divisions of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Somers
Virend K
VK
Divisions of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Olson
Lyle J
LJ
Divisions of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Caples
Sean M
SM
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: caples.sean@mayo.edu.
D002245:Carbon Dioxide / Q000494:pharmacology* / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012119:Respiration / Q000187:drug effects; D020182:Sleep Apnea, Central / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology
D002245:Carbon Dioxide; D010100:Oxygen