Central Sleep Apnea Presenting As Nocturnal Angina

Abstract

Sleep disordered breathing is a common under diagnosed problem in patients with cardiac failure. Common forms of sleep disordered breathing seen in patients with cardiac failure are obstructive sleep apnea and central sleep apnea with Cheyne Stokes breathing. Central sleep apnea (CSA) can lead to greater cardiovascular outcomes and mortality.  Patients with central sleep apnea are usually thin and do not snore heavily.  Symptoms of CSA and cardiac failure often overlap. So a high index of suspicion is required to recognise CSA in cardiac failure patients. Standard overnight polysomnography should be considered in patients with risk factors for CSA such as male sex, age> 60, atrial fibrillation, hypocapnia, left ventricular ejection fraction< 40%, NYHA class III - IV and refractory cardiac failure with standard medical management. Treatment of CSA can reduce cardiovascular mortality and improve quality of life.