{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:02:26Z","timestamp":1784203346920,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Obstructive sleep apnea (OSA) is highly prevalent among patients with asymptomatic left ventricular systolic and diastolic dysfunction and congestive heart failure, and if untreated may contribute to the clinical progression of heart failure (HF). Given the health and economic burden of HF, identifying potential modifiable risk factors such as OSA and whether appropriate treatment improves outcomes is of critical importance. Identifying the subgroups of patients with OSA and HF who would benefit most from OSA treatment is another important point. This focused review surveys current knowledge of OSA and HF in order to provide: (1) a better understanding of the pathophysiologic mechanisms that may increase morbidity among individuals with HF and comorbid OSA, (2) a summary of current observational data and small randomized trials, (3) an understanding of the limitations of current larger randomized controlled trials, and (4) future needs to more accurately determine the efficacy of OSA treatment among individuals with HF.<\/jats:p>","DOI":"10.3390\/jcm11123458","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T01:48:12Z","timestamp":1655430492000},"page":"3458","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Obstructive Sleep Apnea in Heart Failure: Current Knowledge and Future Directions"],"prefix":"10.3390","volume":"11","author":[{"given":"Shahrokh","family":"Javaheri","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH 45242, USA"},{"name":"Division of Cardiology, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Division of Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH 45242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sogol","family":"Javaheri","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000102","DOI":"10.1161\/HCQ.0000000000000102","article-title":"2021 ACC\/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure)","volume":"14","author":"Bozkurt","year":"2021","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.chest.2019.02.407","article-title":"Apneas of Heart Failure and Phenotype-Guided Treatments: Part One: OSA","volume":"157","author":"Javaheri","year":"2020","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9978906","DOI":"10.1155\/2021\/9978906","article-title":"Prevalence and Patterns of Sleep-Disordered Breathing in Indian Heart Failure Population","volume":"2021","author":"Kishan","year":"2021","journal-title":"Pulm. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1093\/eurjhf\/hfp057","article-title":"Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction","volume":"11","author":"Bitter","year":"2009","journal-title":"Eur. J. Heart Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","article-title":"Sleep Apnea: Types, Mechanism, and Clinical Cardiovascular Consequences","volume":"69","author":"Javaheri","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.cardfail.2011.01.013","article-title":"High prevalence of sleep apnea in heart failure outpatients: Even in patients with preserved systolic function","volume":"17","author":"Herrscher","year":"2011","journal-title":"J. Card. Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1164\/rccm.201003-0406OC","article-title":"Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure","volume":"183","author":"Javaheri","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/j.jacc.2006.12.046","article-title":"Influence of obstructive sleep apnea on mortality in patients with heart failure","volume":"49","author":"Wang","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1093\/eurheartj\/ehu522","article-title":"Sleep disordered breathing and post-discharge mortality in patients with acute heart failure","volume":"36","author":"Khayat","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1164\/rccm.201903-0692OC","article-title":"Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index: The Importance of Tongue Fat","volume":"201","author":"Wang","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3949\/ccjm.86.s1.03","article-title":"Sleep apnea and the heart","volume":"86","author":"Mehra","year":"2019","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1378\/chest.07-1901","article-title":"Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure","volume":"133","author":"Kasai","year":"2008","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.cardfail.2020.06.007","article-title":"In-Hospital Management of Sleep Apnea During Heart Failure Hospitalization: A Randomized Controlled Trial","volume":"26","author":"Khayat","year":"2020","journal-title":"J. Card. Fail."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.chest.2017.08.003","article-title":"OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study","volume":"152","author":"Uchoa","year":"2017","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1056\/NEJMoa2107038","article-title":"Empagliflozin in heart failure with preserved ejection fraction","volume":"385","author":"Anker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1056\/NEJMoa1606599","article-title":"CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea","volume":"375","author":"McEvoy","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1001\/archinte.167.8.757","article-title":"The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: Evidence from a meta-analysis of placebo-controlled randomized trials","volume":"167","author":"Haentjens","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1136\/thx.2007.088096","article-title":"Predictors of blood pressure fall with continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea (OSA)","volume":"63","author":"Robinson","year":"2008","journal-title":"Thorax"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2994","DOI":"10.1093\/eurheartj\/ehz273","article-title":"The hypoxic burden: A novel sleep apnoea severity metric and a predictor of cardiovascular mortality-Reply to \u2018The hypoxic burden: Also known as the desaturation severity parameter\u2019","volume":"40","author":"Azarbarzin","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.chest.2020.03.053","article-title":"The Sleep Apnea-Specific Hypoxic Burden Predicts Incident Heart Failure","volume":"158","author":"Azarbarzin","year":"2020","journal-title":"Chest"},{"key":"ref_21","first-page":"1071","article-title":"Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin Sleep Cohort","volume":"31","author":"Young","year":"2008","journal-title":"Sleep"},{"key":"ref_22","first-page":"1079","article-title":"Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study","volume":"31","author":"Marshall","year":"2008","journal-title":"Sleep"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Punjabi, N.M., Caffo, B.S., and Goodwin, J.L. (2009). Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000132"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.chest.2019.09.002","article-title":"Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine","volume":"157","author":"Zinchuk","year":"2020","journal-title":"Chest"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1183\/09031936.00032314","article-title":"The different clinical faces of obstructive sleep apnoea: A cluster analysis","volume":"44","author":"Ye","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1164\/rccm.201808-1509OC","article-title":"Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes","volume":"200","author":"Mazzotti","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2989","DOI":"10.1093\/eurheartj\/ehz274","article-title":"Hypoxic burden captures sleep apnoea-specific nocturnal hypoxaemia","volume":"40","author":"Azarbarzin","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/clc.22738","article-title":"Obstructive sleep apnea is associated with increased readmission in heart failure patients","volume":"40","author":"Sommerfeld","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ijcard.2012.09.101","article-title":"Effective sleep apnoea treatment improves cardiac function in patients with chronic heart failure","volume":"168","author":"Kourouklis","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.sleep.2007.06.018","article-title":"Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: A multicenter study","volume":"9","author":"Egea","year":"2008","journal-title":"Sleep Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3458\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:32:55Z","timestamp":1760139175000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,16]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11123458"],"URL":"https:\/\/doi.org\/10.3390\/jcm11123458","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,16]]}}}