Sleep-related breathing disorders and acute heart failure syndrome

An association between severe heart failure and a form of breathing irregularity, Cheyne-Stokes respiration (CSR), has been recognized for well over two centuries. Only in the past three decades, however, has intensive epidemiologic and experimental work uncovered an intriguing and reciprocal relationship between sleep-related breathing disorders (SRBDs) and cardiovascular disease. For example, obstructive sleep apnea hypopnea syndrome (OSAHS, also known more simply as obstructive sleep apnea or OSA) causes hypertension, left ventricular hypertrophy, and early atherosclerosis. Obstructive sleep apnea also worsens ischemic heart disease and cardiac arrhythmias, and it is an independent risk factor for the development of heart failure. That is, in otherwise healthy individuals, OSA can be a cause of cardiac dysfunction, and in patients with existing cardiovascular disorders, OSA can accelerate the progression to heart failure, or induce an exacerbation of underling chronic heart failure (1, 2).