Volume 180 - Issue 3
Heart failure: how can we prevent the epidemic?
Author: Duncan J Campbell
Med J Aust 2004; 180 (3): 143. || doi: 10.5694/j.1326-5377.2004.tb05847.x
Published online: 2 February 2004
Published online: 2 February 2004
Duncan J Campbell
Senior Research Fellow, St Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, VIC 3065. J.CampbellATmedicine.unimelb.edu.au
In reply: I am grateful to Naughton and colleagues for their contribution to the debate about how we might prevent the epidemic of heart failure.
I agree that both obstructive and central sleep apnoea are frequently associated with heart failure and that treatment of sleep apnoea can improve cardiac function. However, as indicated by its title, my article focused on how we might prevent heart failure. Central sleep apnoea in heart failure is usually the consequence of the heart failure.1 Heart failure may contribute to obstructive sleep apnoea as well,2 and obstructive sleep apnoea may, in turn, be an important contributor to heart failure pathogenesis.
Epidemiological evidence links obesity with hypertension and obstructive sleep apnoea.3 Significant sleep apnoea is present in about 40% of obese people, and about 70% of people with obstructive sleep apnoea are obese.3 Obesity and obstructive sleep apnoea may each contribute to one another, and both may contribute to hypertension. The need to prevent obstructive sleep apnoea is an argument for more effective prevention of obesity. In addition to reducing its metabolic consequences, preventing obesity is likely to reduce the incidence of hypertension and obstructive sleep apnoea, and to thereby decrease the incidence of heart failure.
For people with obstructive sleep apnoea not caused by obesity, alternative strategies will be required to prevent and treat the sleep apnoea and thus prevent its consequences.
References
- Bradley TD, Floras JS. Sleep apnea and heart failure. Part II: central sleep apnea. Circulation 2003; 107: 1822-1826. r2
- Bradley TD, Floras JS. Sleep apnea and heart failure. Part I: obstructive sleep apnea. Circulation 2003; 107: 1671-1678.
- Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension 2003; 42: 1067-1074. i1082889