ABSTRACT
I. Introduction The prevalence of either obstructive sleep apnea (OSA) or central sleep apnea (CSA), or a combination of both, is in excessive of 50% of heart failure (HF) patients. Untreated OSA is thought to be detrimental toward the failing heart, whereas CSA is considered a result of advanced HF. The effectiveness of OSA treatment in HF populations is indicated by short-and medium-term studies that show OSA reversal with continuous positive airway pressure (CPAP) is associated with improvements in objective and subjective measures of HF. In the case of CSA and HF, most treatments directed toward HF have a beneficial effect upon the severity of CSA, suggesting HF and CSA severity change in parallel with each other. Nevertheless, it has also been shown that therapies directed toward relieving CSA, especially CPAP, can improve objective measures of cardiovascular function. Consequently, it would appear that CSA may have adverse effects on cardiovascular function, independent of HF status. Thus, the identification of OSA and CSA, the pathophysiological links between sleep apnea and HF, and the projected aims of therapy may vary between the two apnea types. This review will attempt to clarify indications for treatment, goals of therapy, and treatment modalities tried for OSA and CSA in the HF population.
