Mechanisms of Sleep Apnea and Periodic Breathing in Systolic Heart Failure

Periodic breathing and central sleep apnea are common in patients with systolic heart failure. The mechanisms of central sleep apnea are complex. Recent studies have demonstrated that those patients with systolic heart failure who have increased CO2 chemosensitivity below and above eupnea are prone to develop central apnea during sleep. Obstructive sleep apnea also occurs frequently in patients with heart failure, particularly in those with obesity who presumably have alterations in the mechanical properties of the upper airway. This article reviews the mechanisms of central sleep apnea, obstructive sleep apnea, and periodic breathing in systolic heart failure.