Sleep-Disordered Breathing and Heart Failure Interactions and Controversies

Sleep-disordered breathing (SDB) including both obstructive and central sleep apnea affects up to 70% of all patients with cardiovascular disease. There are multiple mechanisms of abnormal physiology in SDB at play that are deleterious to the heart failure (HF) patient, including intermittent hypoxia, sympathetic overdrive, and endothelial dysfunction accompanied by oxidative stress. The mainstay of treatment of SDB in HF patients involves the use of positive airway pressure devices similar to that in non-HF patients. Evaluation and treatment of SDB in patients with HF can improve survival and quality of life and likely decrease arrhythmia.