title: Heart Failure and Sleep Apnea.
abstract: Obstructive and central sleep apnea are far more common in heart failure patients than in the general population and their presence might contribute to the progression of heart failure by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic nervous system activation, and vascular endothelial dysfunction. There is now substantial evidence that supports a role for fluid overload and nocturnal rostral fluid shift from the legs as unifying mechanisms in the pathogenesis of obstructive and central sleep apnea in heart failure patients, such that the predominant type of sleep apnea is related to the relative distribution of fluid from the leg to the neck and chest. Despite advances in therapies for heart failure, mortality rates remain high. Accordingly, the identification and treatment of sleep apnea in patients with heart failure might offer a novel therapeutic target to modulate this increased risk. In heart failure patients with obstructive or central sleep apnea, continuous positive airway pressure has been shown to improve cardiovascular function in short-term trials but this has not translated to improved mortality or reduced hospital admissions in long-term randomized trials. Other forms of positive airway pressure such as adaptive servoventilation have shown promising results in terms of attenuation of sleep apnea and improvement in cardiovascular function in short-term trials. Large scale, randomized trials are required to determine whether treating sleep apnea with various interventions can reduce morbidity and mortality.
authors.affiliation: Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Owen D
authors.initials: OD
authors.lastname: Lyons
authors.affiliation: Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, Ontario, Canada; Department of Medicine of the University Health Network Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: douglas.bradley@utoronto.ca.
authors.forename: T Douglas
authors.initials: TD
authors.lastname: Bradley
mesh_terms: D018450:Disease Progression; D014943:Global Health; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology*