Generic placeholder image

Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Review Article

Disturbed Sleep is Not Good for the Heart: A Narrative Review

Author(s): Meet Patel*, Harshani Yarlagadda, Shubekshya Upadhyay, Ritesh Neupane, Umer Qureshi, Joseph D. Raco, Rahul Jain and Rohit Jain

Volume 19, Issue 3, 2023

Published on: 27 December, 2022

Article ID: e301122211378 Pages: 7

DOI: 10.2174/1573403X19666221130100141

Price: $65

Open Access Journals Promotions 2
Abstract

Sleep-related breathing disorders, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), have a major impact on cardiovascular function. It has shown an association with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and congestive heart failure (CHF). This review focuses on highlighting the relationship between sleep apnea and CHF. We discuss the underlying pathophysiology, which involves the mechanical, neurohormonal, and inflammatory mechanisms; in addition, the similarities and differentiating clinical features of OSA in patients with CHF and without CHF. We have also discussed several treatment strategies, including weight loss, continuous positive airway pressure (CPAP), supplemental oxygen therapy, theophylline, acetazolamide, mandibular advancement device, and hypoglossal nerve stimulation (HGNS). We conclude that since there are several overlapping clinical features in patients with OSA with Heart Failure (HF) and without HF, early detection and treatment are crucial to decrease the risk of HF, coronary artery disease, and stroke.

Keywords: Obstructive sleep apnea/pathophysiology, apnea-hypopnea index, congestive heart failure, continuous airway positive pressure, mandibular advancement device, hypoglossal nerve stimulation.

Graphical Abstract
[1]
Jun JC, Chopra S, Schwartz AR. Sleep apnoea. Eur Respir Rev 2016; 25(139): 12-8.
[http://dx.doi.org/10.1183/16000617.0077-2015] [PMID: 26929416]
[2]
Lurie A. Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol 2011; 46: 1-42.
[http://dx.doi.org/10.1159/000327660] [PMID: 22005188]
[3]
Mohsenin V. Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea. Sleep Med 2003; 4(6): 523-9.
[http://dx.doi.org/10.1016/S1389-9457(03)00168-0] [PMID: 14607346]
[4]
Malhotra A, Ayappa I, Ayas N, et al. Metrics of sleep apnea severity: beyond the apnea-hypopnea index. Sleep 2021; 44(7): zsab030.
[http://dx.doi.org/10.1093/sleep/zsab030] [PMID: 33693939]
[5]
Khattak HK, Hayat F, Pamboukian SV, Hahn HS, Schwartz BP, Stein PK. Obstructive sleep apnea in heart failure: Review of prevalence, treatment with continuous positive airway pressure, and prognosis. Tex Heart Inst J 2018; 45(3): 151-61.
[http://dx.doi.org/10.14503/THIJ-15-5678] [PMID: 30072851]
[6]
Strömberg A, Mårtensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs 2003; 2(1): 7-18.
[http://dx.doi.org/10.1016/S1474-5151(03)00002-1] [PMID: 14622644]
[7]
Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation 2003; 107(12): 1671-8.
[http://dx.doi.org/10.1161/01.CIR.0000061757.12581.15] [PMID: 12668504]
[8]
Schulz R, Blau A, Börgel J, et al. Sleep apnoea in heart failure. Eur Respir J 2007; 29(6): 1201-5.
[http://dx.doi.org/10.1183/09031936.00037106] [PMID: 17360729]
[9]
Rudrappa M, Modi P, Bollu PC. Cheyne Stokes RespirationsStatPearls, StatPearls Publishing Copyright © 2022. StatPearls Publishing LLC 2022.
[10]
Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med 2008; 4(3): 261-72.
[http://dx.doi.org/10.5664/jcsm.27191] [PMID: 18595441]
[11]
Javaheri S, Javaheri S, Javaheri A. Sleep apnea, heart failure, and pulmonary hypertension. Curr Heart Fail Rep 2013; 10(4): 315-20.
[http://dx.doi.org/10.1007/s11897-013-0167-3] [PMID: 24097114]
[12]
Trinder J, Kleiman J, Carrington M, et al. Autonomic activity during human sleep as a function of time and sleep stage. J Sleep Res 2001; 10(4): 253-64.
[http://dx.doi.org/10.1046/j.1365-2869.2001.00263.x] [PMID: 11903855]
[13]
Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 1993; 328(5): 303-7.
[http://dx.doi.org/10.1056/NEJM199302043280502] [PMID: 8419815]
[14]
Arjun P, Nair SC, Azeez A, Nair S. Proportion of rapid eye movement sleep related obstructive sleep apnea (REM related OSA) in patients with sleep disordered breathing: A cross sectional study. Lung India 2022; 39(1): 38-43.
[http://dx.doi.org/10.4103/lungindia.lungindia_64_21] [PMID: 34975051]
[15]
Ryan CM, Bradley TD. Pathogenesis of obstructive sleep apnea. J Appl Physiol 2005; 99(6): 2440-50.
[http://dx.doi.org/10.1152/japplphysiol.00772.2005] [PMID: 16288102]
[16]
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 2010; 121(14): 1598-605.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.902452] [PMID: 20351237]
[17]
Chiu KL, Ryan CM, Shiota S, et al. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med 2006; 174(12): 1378-83.
[http://dx.doi.org/10.1164/rccm.200607-927OC] [PMID: 16998093]
[18]
Redolfi S, Yumino D, Ruttanaumpawan P, et al. Relationship between overnight rostral fluid shift and obstructive sleep apnea in nonobese men. Am J Respir Crit Care Med 2009; 179(3): 241-6.
[http://dx.doi.org/10.1164/rccm.200807-1076OC] [PMID: 19011149]
[19]
Shiota S, Ryan CM, Chiu KL, et al. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax 2007; 62(10): 868-72.
[http://dx.doi.org/10.1136/thx.2006.071183] [PMID: 17442706]
[20]
Su MC, Chiu KL, Ruttanaumpawan P, et al. Lower body positive pressure increases upper airway collapsibility in healthy subjects. Respir Physiol Neurobiol 2008; 161(3): 306-12.
[http://dx.doi.org/10.1016/j.resp.2008.03.004] [PMID: 18439881]
[21]
Brinker JA, Weiss JL, Lappé DL, et al. Leftward septal displacement during right ventricular loading in man. Circulation 1980; 61(3): 626-33.
[http://dx.doi.org/10.1161/01.CIR.61.3.626] [PMID: 7353253]
[22]
Orban M, Bruce CJ, Pressman GS, et al. Dynamic changes of left ventricular performance and left atrial volume induced by the mueller maneuver in healthy young adults and implications for obstructive sleep apnea, atrial fibrillation, and heart failure. Am J Cardiol 2008; 102(11): 1557-61.
[http://dx.doi.org/10.1016/j.amjcard.2008.07.050] [PMID: 19026314]
[23]
Bradley TD, Hall MJ, Ando S, Floras JS. Hemodynamic effects of simulated obstructive apneas in humans with and without heart failure. Chest 2001; 119(6): 1827-35.
[http://dx.doi.org/10.1378/chest.119.6.1827] [PMID: 11399711]
[24]
Somers VK, Mark AL, Zavala DC, Abboud FM. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol 1989; 67(5): 2095-100.
[http://dx.doi.org/10.1152/jappl.1989.67.5.2095] [PMID: 2513315]
[25]
Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol 2011; 57(2): 119-27.
[http://dx.doi.org/10.1016/j.jacc.2010.08.627] [PMID: 21211682]
[26]
Ip MSM, Lam B, Chan LY, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000; 162(6): 2166-71.
[http://dx.doi.org/10.1164/ajrccm.162.6.2002126] [PMID: 11112132]
[27]
Carlson JT, Rångemark C, Hedner JA. Attenuated endothelium-dependent vascular relaxation in patients with sleep apnoea. J Hypertens 1996; 14(5): 577-84.
[http://dx.doi.org/10.1097/00004872-199605000-00006] [PMID: 8762200]
[28]
Shamsuzzaman ASM, Winnicki M, Lanfranchi P, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002; 105(21): 2462-4.
[http://dx.doi.org/10.1161/01.CIR.0000018948.95175.03] [PMID: 12034649]
[29]
Garvey JF, Taylor CT, McNicholas WT. Cardiovascular disease in obstructive sleep apnoea syndrome: The role of intermittent hypoxia and inflammation. Eur Respir J 2009; 33(5): 1195-205.
[http://dx.doi.org/10.1183/09031936.00111208] [PMID: 19407053]
[30]
Westermann D, Lindner D, Kasner M, et al. Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail 2011; 4(1): 44-52.
[http://dx.doi.org/10.1161/CIRCHEARTFAILURE.109.931451] [PMID: 21075869]
[31]
Drager LF, Bortolotto LA, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007; 176(7): 706-12.
[http://dx.doi.org/10.1164/rccm.200703-500OC] [PMID: 17556718]
[32]
Lu M, Wang Z, Zhan X, Wei Y. Obstructive sleep apnea increases the risk of cardiovascular damage: A systematic review and meta-analysis of imaging studies. Syst Rev 2021; 10(1): 212.
[http://dx.doi.org/10.1186/s13643-021-01759-6] [PMID: 34330323]
[33]
Raut S, Gupta G, Narang R, et al. The impact of obstructive sleep apnoea severity on cardiac structure and injury. Sleep Med 2021; 77: 58-65.
[http://dx.doi.org/10.1016/j.sleep.2020.10.024] [PMID: 33310689]
[34]
Figueroa MS, Peters JI. Congestive heart failure: Diagnosis, pathophysiology, therapy, and implications for respiratory care. Respir Care 2006; 51(4): 403-12.
[PMID: 16563194]
[35]
Javaheri S. Basics of Sleep Apnea and Heart Failure 2013. Available from: https://www.acc.org/latest-incardiology/ articles/2014/07/22/08/25/basics-of-sleep-apnea-andheart- failure
[36]
Arzt M, Young T, Finn L, et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006; 166(16): 1716-22.
[http://dx.doi.org/10.1001/archinte.166.16.1716] [PMID: 16983049]
[37]
Taranto Montemurro L, Floras JS, Millar PJ, et al. Inverse relationship of subjective daytime sleepiness to sympathetic activity in patients with heart failure and obstructive sleep apnea. Chest 2012; 142(5): 1222-8.
[http://dx.doi.org/10.1378/chest.11-2963] [PMID: 23303285]
[38]
Jehan S, Zizi F, Pandi-Perumal SR, et al. Obstructive sleep apnea and obesity: Implications for public health. Sleep Med Disord 2017; 1(4): 00019.
[PMID: 29517065]
[39]
Tham KW, Lee PC, Lim CH. Weight management in obstructive sleep apnea. Sleep Med Clin 2019; 14(1): 143-53.
[http://dx.doi.org/10.1016/j.jsmc.2018.10.002] [PMID: 30709529]
[40]
Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: Implications for treatment. Chest 2010; 137(3): 711-9.
[http://dx.doi.org/10.1378/chest.09-0360] [PMID: 20202954]
[41]
Lu D, Li N, Yao X, Zhou L. Potential inflammatory markers in obstructive sleep apnea-hypopnea syndrome. Bosn J Basic Med Sci 2016; 17(1): 47-53.
[http://dx.doi.org/10.17305/bjbms.2016.1579] [PMID: 27754829]
[42]
Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT. Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med 2011; 183(4): 539-46.
[http://dx.doi.org/10.1164/rccm.201003-0406OC] [PMID: 20656940]
[43]
Egea CJ, Aizpuru F, Pinto JA, et al. Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: A multicenter study. Sleep Med 2008; 9(6): 660-6.
[http://dx.doi.org/10.1016/j.sleep.2007.06.018] [PMID: 17904420]
[44]
Arzt M, Bradley TD. Treatment of sleep apnea in heart failure. Am J Respir Crit Care Med 2006; 173(12): 1300-8.
[http://dx.doi.org/10.1164/rccm.200511-1745PP] [PMID: 16528015]
[45]
Usui K, Bradley TD, Spaak J, et al. Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure. J Am Coll Cardiol 2005; 45(12): 2008-11.
[http://dx.doi.org/10.1016/j.jacc.2004.12.080] [PMID: 15963401]
[46]
Packer M, Coats AJS, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344(22): 1651-8.
[http://dx.doi.org/10.1056/NEJM200105313442201] [PMID: 11386263]
[47]
Gotsopoulos H, Chen C, Qian J, Cistulli PA. Oral appliance therapy improves symptoms in obstructive sleep apnea: A randomized, controlled trial. Am J Respir Crit Care Med 2002; 166(5): 743-8.
[http://dx.doi.org/10.1164/rccm.200203-208OC] [PMID: 12204875]
[48]
Maresch KJ. Hypoglossal nerve stimulation: effective longterm therapy for obstructive sleep apnea. AANA J 2018; 86(5): 412-6.
[PMID: 31584412]
[49]
Eastwood PR, Barnes M, Walsh JH, et al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 2011; 34(11): 1479-86.
[http://dx.doi.org/10.5665/sleep.1380] [PMID: 22043118]
[50]
Javaheri S, Parker TJ, Wexler L, Liming JD, Lindower P, Roselle GA. Effect of theophylline on sleep-disordered breathing in heart failure. N Engl J Med 1996; 335(8): 562-7.
[http://dx.doi.org/10.1056/NEJM199608223350805] [PMID: 8678934]
[51]
Javaheri S. Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. Am J Respir Crit Care Med 2006; 173(2): 234-7.
[http://dx.doi.org/10.1164/rccm.200507-1035OC] [PMID: 16239622]
[52]
Schmickl CN, Landry SA, Orr JE, et al. Acetazolamide for OSA and central sleep apnea. Chest 2020; 158(6): 2632-45.
[http://dx.doi.org/10.1016/j.chest.2020.06.078] [PMID: 32768459]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy