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Obstructive sleep apnoea, intermittent hypoxia and heart failure with a preserved ejection fraction
  1. John E Sanderson,
  2. Fang Fang,
  3. Mi Lu,
  4. Chen Yao Ma,
  5. Yong Xiang Wei
  1. Beijing Institute of Heart, Lung, and Blood diseases, Capital Medical University Affiliated Anzhen Hospital, Beijing, Chaoyang-qu, China
  1. Correspondence to Dr Fang Fang, Sleep Medical Centre, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; fangfang_ff{at}


Obstructive sleep apnoea (OSA) is recognised to be a potent risk factor for hypertension, coronary heart disease, strokes and heart failure with a reduced ejection fraction. However, the association between OSA and heart failure with a preserved ejection fraction (HFpEF) is less well recognised. Both conditions are very common globally.

It appears that there are many similarities between the pathological effects of OSA and other known aetiologies of HFpEF and its postulated pathophysiology. Intermittent hypoxia induced by OSA leads to widespread stimulation of the sympathetic nervous system, renin–angiotensin–aldosterone system and more importantly a systemic inflammatory state associated with oxidative stress. This is similar to the consequences of hypertension, diabetes, obesity and ageing that are the common precursors to HFpEF. The final common pathway is probably via the development of myocardial fibrosis and structural changes in collagen and myocardial titin that cause myocardial stiffening. Thus, considering the pathophysiology of OSA and HFpEF, OSA is likely to be a significant risk factor for HFpEF and further trials of preventive treatment should be considered.

  • heart failure with preserved ejection fraction
  • heart failure

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  • Contributors JES and FF: concept, writing and review manuscript. MLDrs Lu and CYM: research of background, references, figures and review/editing. YXW: funding grants and review.

  • Funding This work was supported by the National Key Research and Development Program of China (2020YFC2003600)

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.