Congestive heart failure and obstructive sleep apnea

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Congestive Heart Failure Microchapters


Patient Information


Historical Perspective



Systolic Dysfunction
Diastolic Dysfunction


Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray

Cardiac MRI


Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies


Invasive Hemodynamic Monitoring

Medical Therapy:

Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Positive Inotropics
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure and obstructive sleep apnea On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure and obstructive sleep apnea

CDC on Congestive heart failure and obstructive sleep apnea

Congestive heart failure and obstructive sleep apnea in the news

Blogs on Congestive heart failure and obstructive sleep apnea

Directions to Hospitals Treating Congestive heart failure and obstructive sleep apnea

Risk calculators and risk factors for Congestive heart failure and obstructive sleep apnea

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, D.M.D., M.D. [3]


Obstructive sleep apnea is a sleep-related breathing disorder with effects on cardiovascular system by increasing the risk of hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. Obstructive sleep apnea contributes to the development and progression of HF. Hypoxia caused activation of inflammatory pathway leading to endothelial damage, atherogenesis, and heart failure. Activate profibrotic transforming growth factor-β during inflammatory process may cause increased deposition of extracellular matrix and consequent myocardial fibrosis and worsening LV diastolic function.

Sleep apnea in heart failure disease


Effect of CPAP in patients with HFrEF

Effect of CPAP in patients with HFpEF

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [17]

Management of Sleep Disorders

Class IIa
"1. In patients with HF and suspicion of sleep-disordered breathing, a formal sleep assessment is reasonable to confirm the diagnosis and differentiate between obstructive and central sleep apnea. [18][19](Level of Evidence: C-LD) "
"2. In patients with HF and obstructive sleeep apnea, continuous positive airway pressure may be reasonable to improve sleep quality and decrease daytime sleepiness. [18][20][21][22](Level of Evidence: B-R) "
Class III (Harm)
"3. In patients with NYHA class II to IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. [20][21] (Level of Evidence: B-R) "



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  19. Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D; et al. (2007). "Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP)". Circulation. 115 (25): 3173–80. doi:10.1161/CIRCULATIONAHA.106.683482. PMID 17562959.
  20. 20.0 20.1 O'Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ; et al. (2017). "Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial". J Am Coll Cardiol. 69 (12): 1577–1587. doi:10.1016/j.jacc.2017.01.041. PMID 28335841.
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  22. Yamamoto S, Yamaga T, Nishie K, Nagata C, Mori R (2019). "Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure". Cochrane Database Syst Rev. 12: CD012803. doi:10.1002/14651858.CD012803.pub2. PMC 6891032 Check |pmc= value (help). PMID 31797360.
  23. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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