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Treatment of central sleep apnea in patients with heart failure: Now and future

World Journal of Respirology 2019年第1期9卷 1-7页

作者： azusa murata Takatoshi Kasai Department of Cardiovascular Medicine Juntendo University School of Medicine Department of Cardiovascular Medicine Cardiovascular Respiratory Sleep Medicine Juntendo University Graduate School of Medicine

Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased mortality and *** sleep apnea (CSA), typically characterized by Cheyne-Stokes breathing(CSB), is increasingly found in patients with HF compared to the general population. An important pathogenetic factor of CSA seen in HF patients is an instability in the control of the respiratory system, characterized by both hypocapnia and increased chemosensitivity. Sympathetic overactivation,pulmonary congestion and increased chemosensitivity associated with HF stimulate the pulmonary vagal irritant receptor, resulting in chronic hyperventilation and hypocapnia. Additionally, the repetitive apnea and arousal cycles induce cyclic sympathetic activation, which may worsen the cardiac prognosis. Correcting CSB may improve both patient’s quality of life and HF syndrome itself. However, a treatment for HF in patients also experiencing CSA is yet to be found. In fact, conflicting results from numerous clinical studies investigating sleep apnea with HF guide to a troubling question, that is whether(or not) sleep apnea should be treated in patients with HF? This editorial attempts to both collect the current evidence about randomized control trials investigating CSA in patients with HF and highlight the effect of specific CSA treatments on cardiovascular endpoints.

关键词： Central sleep apnea Obstructive sleep apnea Heart failure Positive airway pressure Adaptive servo-ventilation

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