Does Treating Sleep Apnea Reduce Heart Failure Risks?

Sleep-disordered breathing (SDB) is the most common comorbidity in heart failure (HF) patients. SDB, including both central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects up to 70 % of all heart patients. Numerous studies have identified intermittent hypoxia, oxidative stress, and symp...

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Veröffentlicht in:Current cardiovascular risk reports 2016-02, Vol.10 (2), p.11, Article 11
Hauptverfasser: Pleister, Adam, Khayat, Rami N.
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Sprache:eng
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Zusammenfassung:Sleep-disordered breathing (SDB) is the most common comorbidity in heart failure (HF) patients. SDB, including both central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects up to 70 % of all heart patients. Numerous studies have identified intermittent hypoxia, oxidative stress, and sympathetic activation as the main pathways through which SDB exerts its negative cardiovascular consequences. The etiological relation between SDB and HF is complex and multi-layered. On one level, SDB contributes to the progression of cardiovascular disease (CVD) into HF; on another level, SDB is a consequence of severe advanced HF. At all stages of CVD, SDB likely contributes to the acceleration of disease progression into end-stage process including advanced HF, stroke, and death. Figure 1 describes the role of OSA in the progression of CVD risk status, the role of CSA in end-stage CVD (including HF) and the reciprocal relationship between advanced CVD and SDB. Current evidence supports that SDB treatment improves several physiological parameters and disease markers in patients with CVD and likely decreases the progression into HF. In patients with established HF, available evidence supports that untreated SDB is independently associated with negative consequences in heart failure. However, there are insufficient studies in support of a conclusion that treatment of SDB changes important HF outcomes. In particular, there are no adequately powered randomized controlled trials demonstrating improvement in mortality, admissions, or cardiac function in HF patients with SDB therapy. However, treatment of SDB is largely safe, associated with critical functional benefits, and is increasingly better tolerated, allowing for decision-making processes that favor treatment.
ISSN:1932-9520
1932-9563
DOI:10.1007/s12170-016-0488-3