Rostral fluid shifts and other mechanisms of interaction between obstructive sleep apnea and heart failure - a systematic review.
Level 1 - systematic review of randomized trials
Systematic review (PRISMA methodology) investigating pathophysiological mechanisms and therapeutic strategies.
PubMed 39417262 · doi:10.5604/01.3001.0054.6742
What was done
Two authors independently searched the literature and evaluated studies according to PRISMA guidelines to describe the role of nocturnal rostral fluid shifts and associated pathophysiological mechanisms connecting obstructive sleep apnea (OSA) and heart failure (HF), as well as therapeutic implications.
What was found
The abstract reports no quantitative metrics, effect estimates, or study counts. Descriptively, fluid retention in heart failure leads to nocturnal rostral redistribution of fluid from the lower limbs to neck tissues, increasing neck circumference and promoting airway collapse. Resulting negative intrathoracic pressure swings, sleep fragmentation, and sympathetic activation drive cardiac inflammation, fibrosis, and tissue remodeling, establishing a reciprocal disease interaction.
Why it matters
Recognizing nocturnal fluid shift as a driver of OSA in heart failure highlights the need for integrated, multidisciplinary management combining positive airway pressure with fluid-overload reduction strategies.
Limits
The abstract omits key methodological details including databases searched, date ranges, total number of included studies, underlying study designs, and formal risk-of-bias assessments. No quantitative pooled outcomes or statistical comparisons are provided.
Cited by
- supports When lying down horizontally, fluid shifts rostrally into the neck, contributing to upper airway obstruction in sleep apnea.