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Sleep disordered breathing and its treatment in congestive heart failure

Sleep Disorders Centre, Guy’s and St Thomas’ NHS Trust, London, UK

Correspondence to:
Correspondence to:
Dr Liam Cormican
Sleep Disorders Centre, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK; cormitron{at}yahoo.com

ABSTRACT
Sleep disordered breathing (SDB) is a common problem with adverse cardiorespiratory, endocrinological, and endothelial effects. Recent studies demonstrate an even higher prevalence of SDB in congestive heart failure (CHF) than in a randomly selected population, with up to 40% and 11% having Cheyne Stokes respiration–central sleep apnoea and obstructive sleep apnoea–hypopnoea syndromes, respectively. Randomised controlled trials of nocturnal respiratory support for SDB associated with CHF for up to three months demonstrate significant benefits in terms of improvements in left ventricular ejection fraction, markers of sympathetic system activity, and quality of life. Further randomised controlled trials of larger scale and longer duration are required to establish the role and benefit of this intervention for the treatment of this debilitating condition. The evidence for the higher prevalence of SDB in CHF, its pathogenesis, its pathophysiological consequences, and the emerging benefits of respiratory support are reviewed.

Abbreviations: CANPAP, Canadian continuous positive airway pressure; CHF, congestive heart failure; CPAP, continuous positive airway pressure; CSA, central sleep apnoea; CSR, Cheyne-Stokes respiration; NYHA, New York Heart Association; OSAHS, obstructive sleep apnoea hypopnoea syndrome; PCO₂, partial pressure of carbon dioxide; SDB, sleep disordered breathing

Keywords: sleep disordered breathing; heart failure

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