Management of Sleep-Disordered Breathing in Heart Failure

Over the past few decades, sleep-disordered breathing (SBD) was recognized as major comorbid condition affecting the general population with notable increased prevalence in patients with heart failure (HF). The relationship between SDB and HF is multilayered and despite extensive research in this area, the cause-and-effect relationship is not clearly understood. SDB is well known to cause accelerated progression of HF stages and is associated with increased HF morbidity and poor survival. In contrast, worsening heart failure can lead to the development of SBD and parallel increase in its severity. Despite recent breakthrough in SDB treatment and presence of effective therapies that can improve exercise capacity and quality of life, a large portion of HF patients with SDB remain untreated due to the lack of appropriate screening algorithms and practical therapeutic pathways. It is unfortunate that the management of SDB is still missing from routine HF evaluation, while clinical guidelines have not provided clear insight on the management of this prevalent comorbidity. In this review, we will provide overview of SDB and propose practical therapeutic approaches aimed to simplify screening and provide treatment recommendations.