Central Sleep Apnea in Congestive Heart Failure: Prevalence, Mechanisms, Impact, and Therapeutic Options

Shahrokh Javaheri, M.D.

Disclosures

Semin Respir Crit Care Med. 2005;26(1):44-55. 

In This Article

Prognostic Significance of Central Sleep Apnea in Heart Failure

Mortality from heart failure remains high in spite of therapy with vasodilators and β-blockers.[6] Pathophysiological consequences of sleep-related breathing disorders may have adverse effects on myocardial cells, and the function of an already failed left ventricle, especially in the presence of established coronary artery disease. Sleep-related breathing disorders may contribute to mortality in heart failure.

In regard to central sleep apnea, several studies[14,15,60,61,62,63,64,65] but not all,[66,67] of patients with systolic heart failure have shown that central sleep apnea and periodic breathing may decrease survival. A more recent study[65] has shown that presence of periodic breathing during exercise is also a predictor of mortality in heart failure. In this study polysomnography was not performed; however, my assumption is that patients with periodic breathing during exercise should have had severe central apnea during sleep. This is a reasonable assumption because, as noted earlier, sleep has a pronounced effect on breathing, unmasking central apnea.

Although the above studies may be criticized for various reasons, such as inadequate number of patients and differences in age and ejection fraction among various groups, collectively they show a trend toward increased mortality of heart failure patients with central sleep apnea than without. This notion is further supported by improved surrogates of mortality (left ventricular ejection fraction and the level of catecholamines) in systolic heart failure, when central sleep apnea is adequately treated.

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