Abstract
The relationship between heart failure (HF), sleep-disordered breathing and cardiac arrhythmias is complex and poorly understood. Whereas the frequency of predominantly obstructive sleep apnea in HF patients is low and similar or moderately higher to that observed in the general population, central sleep apnea (CSA) has been observed in approximately 50% of HF patients, depending on the methods used to detect CSA and patient selection. Despite this high prevalence, it is still unclear whether CSA is merely a marker or an independent risk factor for an adverse prognosis in HF patients and whether CSA is associated with an increased risk for supraventricular as well as ventricular arrhythmias in HF patients. The current review focuses on the relationship between CSA and atrial fibrillation as the most common atrial arrhythmia in HF patients, and on the relationship between CSA and ventricular tachycardia and ventricular fibrillation as the most frequent cause of sudden cardiac death in HF patients.
Highlights
The frequency of obstructive sleep apnea (OSA) in heart failure (HF) patients is similar or moderately higher to that observed in the general population ranging from 8% in the study by Grimm et al [16], to 38% in the study by Sin et al [1]
Grimm et al [16] found a low OSA prevalence of 8% by screening HF patients, after patients with a history of sleep disordered breathing and patients who were referred to the sleep laboratory for symptoms suggestive of sleep disordered breathing had been excluded, whereas Sin et al [1], found a high OSA prevalence of 38% in a retrospective study including 450 HF patients, all of whom were referred to the sleep laboratory because of suspected sleep disordered breathing
We focus in this review on HF with reduced ejection fraction rather than HF with preserved ejection fraction, i.e., diastolic heart failure, because there is a large body of evidence in the literature with regard to the relationship between arrhythmias, sleep disordered breathing and heart failure with reduced ejection fraction, whereas the relationship between arrhythmias, sleep disordered breathing and diastolic dysfunction with in HF patients with preserved ejection fraction is largely unknown [12,21,23,27]
Summary
Sleep-disordered breathing and cardiac arrhythmias are both highly prevalent findings in patients with heart failure (HF) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. We will briefly summarize our knowledge about the complex interaction between heart failure, sleep-disordered breathing and cardiac arrhythmias (Figure 2). Interaction between Heart Failure, Sleep-Disordered Breathing and Cardiac Arrhythmias Both prevalence and CSA severity have been associated with increased arrhythmogenic risk synergistic to HF severity with increased neurohumoral activation, higher brain natriuretic peptide (BNP) levels, increased pulmonary capillary wedge pressure, and lower ejection fraction [21,23,25,26]. More or less diffuse myocardial fibrosis has been recognized to be the substrate for reentrant ventricular tachyarrhythmias, the most frequent mechanism of sudden death in HF patients (Figure 2)
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