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.<sup>4 Armstrong P.W., Moe G.W. Medical advances in the treatment of congestive heart failure Circulation 1994 ;  88 : 2941-2952

Cliccare qui per andare alla sezione Riferimenti, 96 Young T., Palta M., Dempsey J. , e al. The occurrence of sleep-disordered breathing among middle-age adults N Engl J Med 1993 ;  328 : 1230-1235  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> There appears to be considerable overlap between the two disorders. In two studies,<sup>51 Javaheri S., Parker T.J., Wexler L. , e al. Occult sleep-disordered breathing in stable congestive heart failure Ann Intern Med 1995 ;  122 : 487-492

Cliccare qui per andare alla sezione Riferimenti, 64 Naughton M.T., Liu P.P., Benard D.C. , e 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

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>2 Andreas S., Hagenah G., Moller C. , e al. Cheyne-Stokes respiration and prognosis in congestive heart failure Am J Cardiol 1996 ;  78 : 1260-1264  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 31 Findley L.J., Zwillich C.W., Ancoli-Israel S. , e al. Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure South Med J 1985 ;  78 : 11-15  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 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

Cliccare qui per andare alla sezione Riferimenti</sup> Other studies<sup>56 Malone S., Liu P.P., Holloway R. , e al. Obstructive sleep apnoea in patients with idiopathic dilated cardiomyopathy: Effects of continuous positive airway pressure Lancet 1991 ;  338 : 1480-1484

Cliccare qui per andare alla sezione Riferimenti, 64 Naughton M.T., Liu P.P., Benard D.C. , e 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

Cliccare qui per andare alla sezione Riferimenti, 85 Takasaki Y., Orr D., Popkin J. , e 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]

Cliccare qui per andare alla sezione Riferimenti</sup> 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%.<sup>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

Cliccare qui per andare alla sezione Riferimenti</sup> That is a death rate that rivals that of many malignancies.<sup>4 Armstrong P.W., Moe G.W. Medical advances in the treatment of congestive heart failure Circulation 1994 ;  88 : 2941-2952

Cliccare qui per andare alla sezione Riferimenti</sup> 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.