Continuous Positive Airway Pressure And Cardiac Failure

Sleep apnea of both central and obstructive nature is common in patients with cardiac failure (123). It has been suggested that OSA may cause or exacerbate ventricular dysfunction by a number of mechanisms. These include increasing left ventricular afterload through the combined effects of elevations in systemic blood pressure and the generation of exaggerated negative intrathoracic pressure, and by activating the sympathetic nervous system through the influence of hypoxia and arousals from sleep (124). Use of nasal CPAP in OSA and in cardiac failure patients for one month (125) and three months (126), respectively, leads to improvement in left ventricular function.

A number of studies have reported the presence of central sleep apnea in patients with ventricular dysfunction. Central apnea appears to be an adverse prognostic factor in such patients (127). Studies, including some with a randomized controlled design, have demonstrated improvement in various endpoints, including reduced mitral regurgitant fraction, atrial natriuretic factor secretion, inspiratory muscle strength, reduced left ventricular afterload, tendency to normalization of PaCO2, and norepinephrine concentrations, with CPAP treatment in patients with cardiac failure and central apnea (127). However, recently published research, while confirming small physiological changes with active treatment, has shown no advantage on survival or transplant-free interval in such patients treated with CPAP (128). That study included several methodological issues which, in retrospect, may have led to the reported outcomes. It is also possible changes in effective cardiac failure therapy over time and during the life of this study may have influenced the essentially negative results of the Canadian Continuous Positive Airway Pressure Trial for Congestive Heart Failure Patients with Central Sleep Apnea (CANPAP) study (129). It is also possible that further sub-group analysis may demonstrate a particular type of patient with cardiac failure and central apneas who may benefit from CPAP therapy.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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