Sleep Disordered Breathing in Patients with Heart Failure: Pathophysiology and Management |
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Authors: | Bhavneesh Sharma David McSharry Atul Malhotra |
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Institution: | Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, BLI 035M, Boston, MA, 02115, USA, bksharma@partners.org. |
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Abstract: | Sleep disordered breathing (SDB) is common in heart failure patients across the range of ejection fractions and is associated
with adverse prognosis. Although effective pharmacologic and device-based treatment of heart failure may reduce the frequency
or severity of SDB, heart failure treatment alone may not be adequate to restore normal breathing during sleep. Continuous
positive airway pressure (CPAP) is the major treatment for SDB in heart failure, especially if obstructive rather than central
sleep apnea (CSA) predominates. Adequate suppression of CSA by PAP is associated with a heart transplant-free survival benefit,
although randomized trials are ongoing. Bilevel PAP (BPAP) may be as effective as CPAP in treating SDB and may be preferable
over CPAP in patients who experience expiratory pressure discomfort. Adaptive (or auto) servo-ventilation (ASV), which adjusts
the PAP depending on the patient’s airflow or tidal volume, may be useful in congestive heart failure patients if CPAP is
ineffective. Other therapies that have been proposed for SDB in congestive heart failure include nocturnal oxygen, CO2 administration (by adding dead space), theophylline, and acetazolamide; most of which have not been systematically studied
in outcome-based prospective randomized trials. |
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