Sleep-disordered breathing in patients with heart failure: pathophysiology, assessment, and management.

Purpose: To provide clinicians in primary care settings information on the effects of sleep-disordered breathing in patients with heart failure (HF). Assessment and screening tools, as well as management considerations, are presented.

Data sources: Review of the scientific literature of the past 10 years, along with classic studies and Internet sources.

Conclusions: HF is an increasingly prevalent problem with a high degree of associated sleep-disordered breathing. There are two broad categories of sleep-disordered breathing: obstructive sleep apnea and central sleep apnea/Cheyne-Stokes breathing. Both of these occur on a continuum of mild hypopnea to severe apnea with hypoxia. Sleep apneas are particularly harmful to patients with HF and, if left untreated, may adversely affect their prognosis. Yet sleep apnea is not routinely screened for in this population.

Implications for practice: Given the serious consequences of untreated sleep-disordered breathing, there is sound justification to screen for sleep apnea in all patients with HF. Subsequent treatment of those patients with sleep apnea can significantly improve their quality of life and can decrease their mortality.