Heart Failure Management: The Neural Pathways by Edoardo Gronda Emilio Vanoli & Alexandru Costea

Author:Edoardo Gronda, Emilio Vanoli & Alexandru Costea
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

8.7 Conclusions

The autonomic nervous system is deeply involved in the mechanisms mediating the cardiovascular effects of sleep within its different stages. Autonomic cardiac control during sleep is characterized by a vagal predominance for most of the time that is interrupted by bursts of sympathetic activity during arousals in NREM sleep and even more during the phasic REM sleep periods. The autonomic fluctuation during sleep associated with the lasting sympathetic activation that occurs in many cardiovascular diseases, particularly heart failure, sets the stage for an increased susceptibility to life-threatening arrhythmias. Sleep apneas, which are a common comorbidity in patients with heart failure, further complicate the picture of autonomic dysregulation and the risk of cardiac events in these subjects by eliciting a further sympathetic activation mostly due to the associated oxygen desaturation and recurrent arousals. Further understanding of the pathophysiological pathways linking sleep disorders to cardiac events is however important to improve clinical management and reduce cardiovascular risk.

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