Reply to Borrelli et al.: Novel Drug Targets for Central Apneas in Heart Failure: On the Road

From the Authors:

We thank the authors for calling attention to an important recent study on examining the use of pharmacotherapy with buspirone in patients with central sleep apnea related to heart failure with reduced ejection fraction (1) in our recent statement (2). As noted, the study found important decreases in chemoreflex sensitivity to carbon dioxide without changes in sensitivity to oxygen. These findings lend support to emerging evidence that central chemoreceptors play an important role in the pathogenesis of central sleep apnea in those with heart failure and stand in contrast to the traditional view that peripheral chemoreceptors are the sole important drivers in this context (3). Although the reductions in the apnea–hypopnea index in this study were modest, this work provides a foundation for much needed novel clinical investigations in addition to clarifying relevant underlying neurobiology.