SLEEP APNEA IN CONGESTIVE HEART FAILURE - 09/09/11

Doi : 10.1016/S0272-5231(05)70435-4

Matthew T. Naughton, MD, FRACP ^b, T. Douglas Bradley, MD, FRCPC ^a

^a Sleep Research Laboratory of the Rehabilitation Institute of Toronto, University of Toronto, Toronto, Ontario, Canada (TDB)

^b Alfred Sleep Disorders and Ventilatory Failure Service, Department of Respiratory Medicine, Alfred Hospital, Prahran, Victoria, Australia (MTN)

Resumen

Sleep apnea and congestive heart failure (CHF) are both common disorders, occurring in approximately 2% to 4% and 1% of the general middle-aged population, respectively.^{4 Armstrong P.W., Moe G.W. Medical advances in the treatment of congestive heart failure Circulation 1994 ; 88 : 2941-2952

Haga clic aquí para ir a la sección de Referencias, 96 Young T., Palta M., Dempsey J. , y al. The occurrence of sleep-disordered breathing among middle-age adults N Engl J Med 1993 ; 328 : 1230-1235 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} There appears to be considerable overlap between the two disorders. In two studies,^{51 Javaheri S., Parker T.J., Wexler L. , y al. Occult sleep-disordered breathing in stable congestive heart failure Ann Intern Med 1995 ; 122 : 487-492

Haga clic aquí para ir a la sección de Referencias, 64 Naughton M.T., Liu P.P., Benard D.C. , y al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure Am J Respir Crit Care Med 1995 ; 151 : 92-97

Haga clic aquí para ir a la sección de Referencias} approximately 40% to 50% of stable symptomatic outpatients with CHF had either obstructive sleep apnea (OSA) or Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). Evidence is also accumulating that sleep-related breathing disorders can contribute to progression of heart failure and affect its prognosis. Several studies, for example, have described higher mortality rates in CHF patients with, than in those without, CSR-CSA.^{2 Andreas S., Hagenah G., Moller C. , y al. Cheyne-Stokes respiration and prognosis in congestive heart failure Am J Cardiol 1996 ; 78 : 1260-1264 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 31 Findley L.J., Zwillich C.W., Ancoli-Israel S. , y al. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure South Med J 1985 ; 78 : 11-15 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 42 Hanly P.J., Zuberi-Khokhar N.S. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure Am J Respir Crit Care Med 1996 ; 153 : 272-276

Haga clic aquí para ir a la sección de Referencias} Other studies^{56 Malone S., Liu P.P., Holloway R. , y al. Obstructive sleep apnoea in patients with idiopathic dilated cardiomyopathy: Effects of continuous positive airway pressure Lancet 1991 ; 338 : 1480-1484

Haga clic aquí para ir a la sección de Referencias, 64 Naughton M.T., Liu P.P., Benard D.C. , y al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure Am J Respir Crit Care Med 1995 ; 151 : 92-97

Haga clic aquí para ir a la sección de Referencias, 85 Takasaki Y., Orr D., Popkin J. , y al. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure American Review of Respiratory Disease 1989 ; 140 : 1578-1584 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} have demonstrated that nightly treatment of either type of sleep apnea with continuous positive airway pressure (CPAP) is associated with marked improvements in cardiac function and symptoms of heart failure.

Despite recent advances in the pharmacologic therapy of CHF, its prognosis remains poor. In the largest and longest study to date, although the angiotensin-converting-enzyme inhibitor, enalapril, reduced mortality compared with placebo, after 3.5 years, mortality among the enalapril treated group was still 35%.^{86 The SOLVD Investigators Effects of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure N Engl J Med 1991 ; 325 : 293-302

Haga clic aquí para ir a la sección de Referencias} That is a death rate that rivals that of many malignancies.^{4 Armstrong P.W., Moe G.W. Medical advances in the treatment of congestive heart failure Circulation 1994 ; 88 : 2941-2952

Haga clic aquí para ir a la sección de Referencias} If the clinical outcome of CHF is to improve, therefore, novel approaches to its treatment will have to be developed. This article reviews data suggesting that one promising approach to improving the prognosis of CHF may be the diagnosis and specific treatment of sleep-related breathing disorders in those patients.

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Esquema

OBSTRUCTIVE SLEEP APNEA

Pathophysiology

Implications for Congestive Heart Failure

Treatment

CHEYNE-STOKES RESPIRATION WITH CENTRAL SLEEP APNEA

Pathophysiology

Implications for Congestive Heart Failure

Treatment

CONCLUSION

Address reprint requests to T. Douglas Bradley, MD, FRCPC, Sleep Research Laboratory, Room 1220, Rehabilitation Institute of Toronto, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada
This work was supported by operating grants MT-11607 and MA-12422 to T. D. Bradley from the Medical Research Council of Canada. T. D. Bradley is a Career Scientist of the Ontario Ministry of Health. M. T. Naughton is a recipient of an Australian Lung Foundation Career Development Award and a Viertal Clinical Investigatorship.