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SEATTLE — Maximizing heart failure therapy helps treat concomitant sleep apnea, Dr. David P. White said at the annual meeting of the Heart Failure Society of America.
Beyond that, treatment for sleep apnea in patients with heart failure relies mainly on continuous positive airway pressure (CPAP), which can regularize disordered breathing and which may improve ejection fraction and quality of life. There are no randomized trial data, however, showing that treating sleep apnea in patients with heart failure decreases mortality or the need for heart transplant, added Dr. White, professor of medicine at Harvard University, Boston.
The most common type of disordered breathing in heart failure patients is Cheyne-Stokes respiration, a variant of central sleep apnea. A number of short, single-center trials suggested that CPAP in patients with heart failure and either central or obstructive sleep apnea could stabilize respiration, improve cardiac function and quality of life, and perhaps reduce the need for cardiac transplantation.
The only randomized, placebo-controlled trial, however, looked at CPAP for patients with heart failure and Cheyne-Stokes respiration and found no difference in quality of life, mortality, or the need for transplant. In the Canadian Positive Airway Pressure trial, CPAP did produce a mean 3% improvement in ejection fraction (not the 8% found in single-center studies), improved oxygenation, and led to a small increase in 6-minute walk distances (N. Engl. J. Med. 2005;353:2025–41).
“First, always maximize the cardiac medications,” Dr. White urged. Studies show that the severity of heart failure predicts, to some degree, the extent of disordered breathing. The severity of Cheyne-Stokes respiration predicts survival rates independently of the severity of heart failure, he added. Other studies suggest that resynchronization therapy also can reduce the severity of disordered breathing, though not in all patients.
After that, consider CPAP for heart failure patients with central sleep apnea, or possibly one of several new devices designed specifically to relieve Cheyne-Stokes respiration, he said. The devices do regularize breathing but there are no long-term studies of their effects on survival, quality of life, or other parameters.
Dr. White is chief medical officer of a company that makes a variety of devices to treat sleep apnea, and is a consultant to other companies with apnea treatments.
SEATTLE — Maximizing heart failure therapy helps treat concomitant sleep apnea, Dr. David P. White said at the annual meeting of the Heart Failure Society of America.
Beyond that, treatment for sleep apnea in patients with heart failure relies mainly on continuous positive airway pressure (CPAP), which can regularize disordered breathing and which may improve ejection fraction and quality of life. There are no randomized trial data, however, showing that treating sleep apnea in patients with heart failure decreases mortality or the need for heart transplant, added Dr. White, professor of medicine at Harvard University, Boston.
The most common type of disordered breathing in heart failure patients is Cheyne-Stokes respiration, a variant of central sleep apnea. A number of short, single-center trials suggested that CPAP in patients with heart failure and either central or obstructive sleep apnea could stabilize respiration, improve cardiac function and quality of life, and perhaps reduce the need for cardiac transplantation.
The only randomized, placebo-controlled trial, however, looked at CPAP for patients with heart failure and Cheyne-Stokes respiration and found no difference in quality of life, mortality, or the need for transplant. In the Canadian Positive Airway Pressure trial, CPAP did produce a mean 3% improvement in ejection fraction (not the 8% found in single-center studies), improved oxygenation, and led to a small increase in 6-minute walk distances (N. Engl. J. Med. 2005;353:2025–41).
“First, always maximize the cardiac medications,” Dr. White urged. Studies show that the severity of heart failure predicts, to some degree, the extent of disordered breathing. The severity of Cheyne-Stokes respiration predicts survival rates independently of the severity of heart failure, he added. Other studies suggest that resynchronization therapy also can reduce the severity of disordered breathing, though not in all patients.
After that, consider CPAP for heart failure patients with central sleep apnea, or possibly one of several new devices designed specifically to relieve Cheyne-Stokes respiration, he said. The devices do regularize breathing but there are no long-term studies of their effects on survival, quality of life, or other parameters.
Dr. White is chief medical officer of a company that makes a variety of devices to treat sleep apnea, and is a consultant to other companies with apnea treatments.
SEATTLE — Maximizing heart failure therapy helps treat concomitant sleep apnea, Dr. David P. White said at the annual meeting of the Heart Failure Society of America.
Beyond that, treatment for sleep apnea in patients with heart failure relies mainly on continuous positive airway pressure (CPAP), which can regularize disordered breathing and which may improve ejection fraction and quality of life. There are no randomized trial data, however, showing that treating sleep apnea in patients with heart failure decreases mortality or the need for heart transplant, added Dr. White, professor of medicine at Harvard University, Boston.
The most common type of disordered breathing in heart failure patients is Cheyne-Stokes respiration, a variant of central sleep apnea. A number of short, single-center trials suggested that CPAP in patients with heart failure and either central or obstructive sleep apnea could stabilize respiration, improve cardiac function and quality of life, and perhaps reduce the need for cardiac transplantation.
The only randomized, placebo-controlled trial, however, looked at CPAP for patients with heart failure and Cheyne-Stokes respiration and found no difference in quality of life, mortality, or the need for transplant. In the Canadian Positive Airway Pressure trial, CPAP did produce a mean 3% improvement in ejection fraction (not the 8% found in single-center studies), improved oxygenation, and led to a small increase in 6-minute walk distances (N. Engl. J. Med. 2005;353:2025–41).
“First, always maximize the cardiac medications,” Dr. White urged. Studies show that the severity of heart failure predicts, to some degree, the extent of disordered breathing. The severity of Cheyne-Stokes respiration predicts survival rates independently of the severity of heart failure, he added. Other studies suggest that resynchronization therapy also can reduce the severity of disordered breathing, though not in all patients.
After that, consider CPAP for heart failure patients with central sleep apnea, or possibly one of several new devices designed specifically to relieve Cheyne-Stokes respiration, he said. The devices do regularize breathing but there are no long-term studies of their effects on survival, quality of life, or other parameters.
Dr. White is chief medical officer of a company that makes a variety of devices to treat sleep apnea, and is a consultant to other companies with apnea treatments.