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Heart failure and sleep disorders

Nature Reviews Cardiology volume 13, pages 389–403 (2016)Cite this article

Subjects

Key Points

  • Patients with heart failure (HF) are characterized by relevant problems during sleep, including short sleep time, low sleep quality, and sleep-disordered breathing

  • Approximately 33% of patients with HF have insomnia, potentially related to HF features, adverse effects of medications, or to conditions that often accompany chronic diseases such as mood disorders and psychological stress

  • ACC/AHA guidelines have identified sleep deprivation and poor sleep quality as barriers to self-care and treatment adherence in patients with HF

  • Sleep-disordered breathing is highly prevalent in patients with HF; both central and obstructive sleep apnoeas are frequently observed in these patients, and were shown to have an important added prognostic value

  • Continuous positive airway pressure has a beneficial effect on left ventricular ejection fraction and is currently the best treatment option for obstructive sleep apnoeas in patients with HF

  • At present, no consensus exists on whether central sleep apnoeas should be treated and what the optimal therapy in HF might be

Abstract

Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.

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Figure 1: Polygraphy records of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA).
Figure 2: Relationship between obstructive sleep apnoea (OSA) and heart failure.
Figure 3: Relationship between central sleep apnoea (CSA) and heart failure.

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Authors and Affiliations

  1. Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Piazza Brescia 20, Milan, 20149, Italy

    Gianfranco Parati, Carolina Lombardi, Francesco Castagna & Paola Mattaliano

  2. Sleep Medicine Centre, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Piazzale Brescia 20, Milan, 20149, Italy

    Gianfranco Parati, Carolina Lombardi, Francesco Castagna & Paola Mattaliano

  3. Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, 20126, Italy

    Gianfranco Parati

  4. Department of Medicine, Columbia University, 622 West 168th Street, New York, 10032, New York, USA

    Francesco Castagna

  5. Department of Advanced Biomedical Sciences, Federico II University, Corso Umberto I 40, Naples, 80138, Italy

    Pasquale Perrone Filardi

  6. Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, 20138, Italy

    Piergiuseppe Agostoni

  7. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy

    Piergiuseppe Agostoni

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Parati, G., Lombardi, C., Castagna, F. et al. Heart failure and sleep disorders. Nat Rev Cardiol 13, 389–403 (2016). https://doi.org/10.1038/nrcardio.2016.71

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