Sleep apnoea in congestive heart failure: one step forwards

Sleep-disordered breathing occurs in approximately 70% of people with congestive heart failure and might have deleterious consequences. 1 Javaheri S Barbe F Campos-Rodriguez F et al. Sleep Apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017; 69: 841-858 Crossref PubMed Scopus (779) Google Scholar Treating obstructive sleep apnoea (OSA) in people with congestive heart failure has been associated with improved surrogate markers, such as cardiac function, 2 Kaneko Y Floras JS Usui K et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003; 348: 1233-1241 Crossref PubMed Google Scholar but randomised controlled trials that are focused on clinical endpoints have not been reported. 3 Malhotra A Cole KV Malik AS et al. Positive airway pressure adherence and health care resource utilization in patients with obstructive sleep apnea and heart failure with reduced ejection fraction. J Am Heart Assoc. 2023; 12e028732 Crossref Scopus (3) Google Scholar Treating central sleep apnoea (CSA) or Cheyne–Stokes breathing in people with congestive heart failure has also been associated with improved clinical outcomes in observational studies, although randomised controlled trials have not reported these effects—both the CANPAP and SERVE-HF studies showed potentially deleterious effects of treating CSA in people with congestive heart failure, 4 Bradley TD Logan AG Kimoff RJ et al. Continuous positive airway pressure for central sleep apnea and heart failure. New Engl J Med. 2005; 353: 2025-2033 Crossref PubMed Scopus (0) Google Scholar , 5 Cowie MR Woehrle H Wegscheider K et al. Adaptive Servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015; 373: 1095-1105 Crossref PubMed Scopus (776) Google Scholar although the underlying mechanisms are unclear. Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): a multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trialIn patients with heart failure and reduced ejection fraction and sleep-disordered breathing, ASV had no effect on the primary composite outcome or mortality but eliminated sleep-disordered breathing safely. Full-Text PDF