scholarly journals Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Circulation ◽  
2021 ◽  
Author(s):  
Yerem Yeghiazarians ◽  
Hani Jneid ◽  
Jeremy R. Tietjens ◽  
Susan Redline ◽  
Devin L. Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Heart Association ◽  
Obstructive Sleep ◽  
Sleep Assessment

Obstructive sleep apnea (OSA) is characterized by recurrent complete and partial upper airway obstructive events, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disturbances are common and underdiagnosed among middle-aged and older adults, and the prevalence varies by race/ethnicity, sex, and obesity status. OSA prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse cardiovascular outcomes, OSA is often underrecognized and undertreated in cardiovascular practice. We recommend screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation. In patients with New York Heart Association class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable. In patients with tachy-brady syndrome or ventricular tachycardia or survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, evaluation for sleep apnea should be considered. After stroke, clinical equipoise exists with respect to screening and treatment. Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have comorbid sleep apnea. All patients with OSA should be considered for treatment, including behavioral modifications and weight loss as indicated. Continuous positive airway pressure should be offered to patients with severe OSA, whereas oral appliances can be considered for those with mild to moderate OSA or for continuous positive airway pressure–intolerant patients. Follow-up sleep testing should be performed to assess the effectiveness of treatment.

scholarly journals Auto positive airway pressure therapy reduces pulmonary pressures in adults admitted for acute heart failure with pulmonary hypertension and obstructive sleep apnea. The ASAP-HF Pilot Trial

SLEEP ◽  
2019 ◽  
Vol 42 (7) ◽  
Author(s):  
Sunil Sharma ◽  
Henrik Fox ◽  
Francisco Aguilar ◽  
Umer Mukhtar ◽  
Leslee Willes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Left Ventricular ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

AbstractObjectivesPulmonary hypertension (PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA), highly prevalent in congestive heart failure patients, may contribute to further elevated pulmonary pressures. This study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.MethodsA two-center randomized control trial comparing standard of care (SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.ResultsTwenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48-hour PAP therapy protocol. In the intervention arm, the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was −15.8 ± 3.2 (58.6 ± 2.5 mm Hg to 42.8 ± 2.7) versus the SOC arm where the mean PASP difference was −5.2 ± 2.6 (62.7 ± 3.3 mm Hg reduced to 57.5 ± 3.9) (p = 0.025). In addition, ejection fraction in the intervention arm improved (3.4 ± 1.5% versus −0.5 ± 0.5 %) (p = 0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic area in the intervention arm but not in NT-pro-BNP or 6-minute walk distance.ConclusionsIn patients with ADHF and OSA, addition of 48 hours of PAP therapy to SOC treatment significantly reduced PH. In addition, PAP therapy was able to improve right and left ventricular function.ClinicalTrials.gov identifier: NCT02963597.

Meta-Analysis of Continuous Positive Airway Pressure as a Therapy of Atrial Fibrillation in Obstructive Sleep Apnea

2015 ◽  
Vol 116 (11) ◽  
pp. 1767-1773 ◽  
Author(s):  
Waqas T. Qureshi ◽  
Usama bin Nasir ◽  
Shehabaldin Alqalyoobi ◽  
Wesley T. O'Neal ◽  
Sagar Mawri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Obstructive Sleep

Automatic positive airway pressure for treatment of obstructive sleep apnea in heart failure

2017 ◽  
Vol 21 (4) ◽  
pp. 273-280 ◽  
Author(s):  
Olaf Oldenburg ◽  
Henrik Fox ◽  
Birgit Wellmann ◽  
Ulrich Thiem ◽  
Dieter Horstkotte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Obstructive Sleep

scholarly journals Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis

2018 ◽  
Vol 45 (3) ◽  
pp. 151-161 ◽  
Author(s):  
Himad K. Khattak ◽  
Faisal Hayat ◽  
Salpy V. Pamboukian ◽  
Harvey S. Hahn ◽  
Brian P. Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Preserved Ejection Fraction ◽  
Obstructive Sleep ◽  
Artery Disease ◽  
The Relationship

Obstructive sleep apnea is a sleep-related breathing disorder that has a major impact on cardiovascular function. It has been associated with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. This review focuses on the relationship between obstructive sleep apnea and heart failure with either reduced or preserved ejection fraction. We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. We also identify areas in which further work is needed to improve our understanding of this association in heart failure patients.

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