Perspective:

This review discusses the pathogenesis and diagnosis of obstructive sleep apnea (OSA), the epidemiology of the condition in heart failure, and the cardiovascular effects of OSA. OSA results from the repetitive collapse of the pharynx during sleep, leading to intermittent hypoxia, excessive negative intrathoracic pressure, and poor sleep quality and quantity. Central sleep apnea often coincides with OSA in patients with heart failure. Patients with OSA demonstrate high sympathetic nervous system activity and reduced vagal tone (and, therefore, reduced heart rate variability), and the authors describe the potential role for OSA in promoting the development or progression of heart failure. Intermittent hypoxia induced by OSA may also increase oxidative stress and promote arrhythmias, including atrial fibrillation. Finally, the authors summarize the results and limitations of published observational and randomized trial results of OSA treatment in heart failure.