help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on March 9, 2006, doi:10.1164/rccm.200511-1745PP

Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1300-1308

A more recent version of this article appeared on June 15, 2006
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200511-1745PPv1
173/12/1300    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Arzt, M.
Right arrow Articles by Bradley, T. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Arzt, M.
Right arrow Articles by Bradley, T. D.

Submitted on November 14, 2005
Accepted on March 8, 2006

Treatment of Sleep Apnea in Heart Failure

Michael Arzt1 and T. Douglas Bradley2*

1 Sleep Research Laboratories of the Toronto Rehabilitation Institute, Toronto, ON, Canada; Toronto General Hospital-University Health Network, Toronto, ON, Canada, 2 Sleep Research Laboratories of the Toronto Rehabilitation Institute, Toronto, ON, Canada; Toronto General Hospital-University Health Network, Toronto, ON, Canada; University of Toronto, Centre for Sleep Medicine and Circadian Biology, Toronto, ON, Canada

* To whom correspondence should be addressed. E-mail: douglas.bradley{at}utoronto.ca.

Obstructive and central sleep apnea are common in heart failure, and may participate in its progression by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic activation and vascular endothelial dysfunction. Treatment of sleep apnea in heart failure patients may reverse these detrimental effects, in addition to alleviating symptoms of sleep apnea. In patients with heart failure and obstructive sleep apnea, short-term randomized trials have demonstrated that continuous positive airway pressure (CPAP) improves cardiac function, and lowers sympathetic activity and blood pressure. However, there are no data on whether treating obstructive sleep apnea in heart failure patients improves morbidity and mortality. Various treatments have been tested in heart failure patients with central sleep apnea, particularly oxygen and CPAP. Both reduce the frequency of central respiratory events, and lower sympathetic activity. In addition, CPAP improves cardiac function. However, the largest randomized trial did not demonstrate any beneficial effect of CPAP on the rate of mortality and cardiac transplantation (32 versus 32 events, in the control and treatment groups, respectively, P=0.54), but ultimately lacked power to conclude with certainty whether CPAP has an effect on morbidity and mortality in such patients. Thus while there are data to indicate that treating both obstructive and central sleep apnea in patients with heart failure improves cardiovascular function, larger randomized trials involving interventions such as oxygen, CPAP, or other forms of positive airway pressure will be required to determine whether treating these sleep-related breathing disorders reduces clinically important outcomes such as morbidity and mortality.
Key words: randomized trial, sleep apnea, positive airway pressure, oxygen




This article has been cited by other articles:


Home page
 ChestHome page
A. Ozsancak, C. D'Ambrosio, and N. S. Hill
Nocturnal Noninvasive Ventilation
Chest, May 1, 2008; 133(5): 1275 - 1286.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. Yumino and T. D. Bradley
Central Sleep Apnea and Cheyne-Stokes Respiration
Proceedings of the ATS, February 15, 2008; 5(2): 226 - 236.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. D. Bradley
Respiratory Sleep Medicine: A Coming of Age
Am. J. Respir. Crit. Care Med., February 15, 2008; 177(4): 363 - 364.
[Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
J Amit Benjamin and K E Lewis
Sleep-disordered breathing and cardiovascular disease
Postgrad. Med. J., January 1, 2008; 84(987): 15 - 22.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
G. Parati, C. Lombardi, and K. Narkiewicz
Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk
Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1671 - R1683.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. Arzt, J. S. Floras, A. G. Logan, R. J. Kimoff, F. Series, D. Morrison, K. Ferguson, I. Belenkie, M. Pfeifer, J. Fleetham, et al.
Suppression of Central Sleep Apnea by Continuous Positive Airway Pressure and Transplant-Free Survival in Heart Failure: A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP)
Circulation, June 26, 2007; 115(25): 3173 - 3180.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. L. Horner and T. D. Bradley
Update in Sleep and Control of Ventilation 2006
Am. J. Respir. Crit. Care Med., March 1, 2007; 175(5): 426 - 431.
[Full Text] [PDF]

Home page
 ChestHome page
D. J. Eckert, A. S. Jordan, P. Merchia, and A. Malhotra
Central Sleep Apnea: Pathophysiology and Treatment
Chest, February 1, 2007; 131(2): 595 - 607.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
W. T. McNicholas, M. R. Bonsignore, and the Management Committee of EU COST ACTION B26
Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities
Eur. Respir. J., January 1, 2007; 29(1): 156 - 178.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2006 American Thoracic Society 		  Solid Organ Transplant for the Intensivist 2008