Sleep apnea: Implications for heart failure

It is likely sleep apnea is highly prevalent in patients with congestive heart failure (CHF). However, as awareness is low and consensus guidelines do not exist, sleep apnea is not routinely screened for or diagnosed in CHF practice. Untreated sleep apnea may promote fatigue as well as left ventricular dysfunction, disease progression, and increased mortality. Available screening tools lack sensitivity or specificity, and there are insufficient numbers of sleep laboratories to accommodate the potentially large number of patient referrals with CHF for definitive diagnosis. In CHF patients with obstructive sleep apnea and sleepiness, treatment includes continuous positive airway pressure which may improve left ventricular function; optimal treatment for the non-sleepy patient is not established. There is no consensus regarding treatment for central sleep apnea. Studies which evaluate cardiovascular endpoints will be necessary to define management strategies for patients with CHF and either obstructive or central sleep apnea.