Positive Airway Pressure in Congestive Heart Failure

Sleep Medicine Clinics 09/2010; 5(3):393-405. DOI: 10.1016/j.jsmc.2010.05.011


Congestive heart failure (CHF) is a common disabling and costly condition, which is responsible for most hospital admissions and has a mortality rate on par with many malignancies. In recent years, positive airway pressure (PAP) has emerged as a novel therapeutic tool for pneumatically splinting open the sleep-related upper airway collapse; increasing lung volume, thereby increasing oxygen storage; and reducing the pressure gradient across the left ventricular wall, thereby reducing afterload. Strong evidence exists of physiologic efficacy and improved survival with PAP in acute pulmonary edema. Good evidence exists of physiologic improvement with PAP in chronic CHF associated with obstructive or central sleep apnea; however, good quality survival data are lacking.

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