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Sleep-disordered breathing and cardiovascular disease: who and why to test and how to intervene?
  1. Ali Vazir1,
  2. Chris J Kapelios2
  1. 1 Royal Brompton and Harfield Hospitals, Part of Guys and St Thomas' NHS Foundation Trust, London UK and Honorary Clinical Senior Lecturer Imperial College London, London, UK
  2. 2 Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
  1. Correspondence to Dr Ali Vazir, Royal Brompton and Harefield Hospitals, Part of Guys and St Thomas' NHS Foundation Trust, London UK and Honorary Clinical Senior Lecturer Imperial College London, London, SW3 6NP, UK; A.vazir{at}imperial.ac.uk

Abstract

Sleep-disordered breathing (SDB) is common in individuals with established cardiovascular disease (CVD), particularly those with heart failure (HF). There are two main types of SDB, central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) which frequently overlap as mixed SDB. Investigating for SDB could be considered in patients with excessive daytime sleepiness, male sex, high body mass index, low ejection fraction, atrial fibrillation (AF), in patients with no dipping blood pressure pattern, recurrent paroxysms of nocturnal dyspnoea or when an apnoea is witnessed. Excessive daytime sleepiness is less likely to be reported by patients with HF than by the general population. In patients with CVD and OSA, continuous positive airway pressure (CPAP) ventilation for over 4 hours daily reduced the risk of major adverse cardiovascular events, but there was no reduction in mortality. In patients with AF and OSA treated with AF ablation, CPAP use was associated with a reduced risk of recurrence of AF. In patients with HF and OSA, small studies have demonstrated that CPAP improves symptoms, brain natriuretic peptide levels and ejection fraction, but data on survival are lacking. Treatment remains unclear in patients with HF and CSA. The presence of CSA may be a defensive adaptive response to HF, and effectively treating CSA as demonstrated in a randomised clinical trial of adaptive servo-ventilation caused more harm than benefit when compared to optimal medical therapy. Thus, the focus of treating CSA should remain on improving the underlying HF by optimising medical therapy and, if indicated, cardiac resynchronisation therapy.

  • heart failure
  • risk factors
  • hypertension

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Footnotes

  • Twitter @avazir1@, @Ckapelios

  • Contributors AV and CJK both wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.