Sleep and quality of life in heart failure and stroke

Abstract

Congestive heart failure (CHF) because of left ventricular systolic dysfunction is a prevalent syndrome and associated with morbidity, mortality, and huge economic cost. Hallmarks of CHF are exercise intolerance, poor prognosis, and poor quality of life (QoL). According to reports from several laboratories, a large number of patients with heart failure also have sleep apnea (SA). SAs cause arousals and sleep disruption, alter blood gases, and increase sympathetic activity. SA has a major impact on QoL, and disturbed sleep itself significantly contributes to depressive syndromes in patients with stable CHF. The correlation of the apnea/hypopnea index (AHI) with most of the QoL measures and depressive syndromes indicates that patients with AHI indices estimated their impaired physical and emotional health status lower as opposed to patients without sleep-related breathing disorder. Fatigue leads to reduced QoL after stroke. Sleep-disordered breathing precedes stroke and may contribute to the development of stroke. It is an independent prognostic factor related to mortality in stroke and associated with fatigue and impaired QoL. Obstructive events seem to be a condition before the neurological disease whereas central events and Cheyne-Stokes respiration (CSR) could be its consequence. In this article, the impact of sleep-disordered breathing on patients with heart failure and stroke and its influence on QoL are discussed. © 2008 Humana Press, Totowa, NJ.