Treatment Options for Cheyne-Stokes Respiration and Heart Failure

A national survey in Japan has revealed that about one of five adults in the general population suffers from a sleep problem [1]. However, sleep-disordered breathing (SDB) had not been well recognized as a substantial health issue in Japan until March of 2003, when a bullet-train driver fell asleep for 8 min while the train was running and an automatic safety system stopped the train while it was traveling at 270 km/h. A few days after this event, the 33-year-old driver was diagnosed as having serious sleep apnea. The Science Council of Japan now has started a national project to promote research, education, technology transfer, and coordination, similar to the Coalition to Wake Up America in the United States. As a matter of course, the awareness of SDB has increased to a significant extent. Nowadays, many people live to an advanced age in Japan, and with the advent of the aging society, congestive heart failure (CHF) has become one of the most important health problems, constituting a major cause of death in elderly patients. Despite development of a number of innovative pharmacological therapies, morbidity and mortality rates of CHF remain still high. Therefore, there have been substantial efforts to determine all treatable conditions that exacerbate CHF. There now is convincing evidence that mortality increases in CHF patients with SDB compared with those without, irrespective of degree of left ventricular (LV) dysfunction. Nevertheless, only limited attention has been paid to SDB as a potential therapeutic target until quite recently. There are two forms of SDB, obstructive sleep apnea (OSA) and central sleep apnea (CSA). Although CSA is relatively rare in the general population, prospective studies revealed that 33% to 82% of patients with CHF have evidence of CSA and characteristic Cheyne-Stokes respiration (CSR).