Sleep‐disordered breathing in heart failure

<jats:p>Sleep‐disordered breathing—comprising obstructive sleep apnoea (<jats:styled-content style="fixed-case">OSA</jats:styled-content>), central sleep apnoea (<jats:styled-content style="fixed-case">CSA</jats:styled-content>), or a combination of the two—is found in over half of heart failure (<jats:styled-content style="fixed-case">HF</jats:styled-content>) patients and may have harmful effects on cardiac function, with swings in intrathoracic pressure (and therefore preload and afterload), blood pressure, sympathetic activity, and repetitive hypoxaemia. It is associated with reduced health‐related quality of life, higher healthcare utilization, and a poor prognosis. Whilst continuous positive airway pressure (<jats:styled-content style="fixed-case">CPAP</jats:styled-content>) is the treatment of choice for patients with daytime sleepiness due to <jats:styled-content style="fixed-case">OSA</jats:styled-content>, the optimal management of <jats:styled-content style="fixed-case">CSA</jats:styled-content> remains uncertain. There is much circumstantial evidence that the treatment of <jats:styled-content style="fixed-case">OSA</jats:styled-content> in <jats:styled-content style="fixed-case">HF</jats:styled-content> patients with <jats:styled-content style="fixed-case">CPAP</jats:styled-content> can improve symptoms, cardiac function, biomarkers of cardiovascular disease, and quality of life, but the quality of evidence for an improvement in mortality is weak. For systolic <jats:styled-content style="fixed-case">HF</jats:styled-content> patients with <jats:styled-content style="fixed-case">CSA</jats:styled-content>, the <jats:styled-content style="fixed-case">CANPAP</jats:styled-content> trial did not demonstrate an overall survival or hospitalization advantage for <jats:styled-content style="fixed-case">CPAP</jats:styled-content>. A minute ventilation‐targeted positive airway therapy, adaptive servoventilation (<jats:styled-content style="fixed-case">ASV</jats:styled-content>), can control <jats:styled-content style="fixed-case">CSA</jats:styled-content> and improves several surrogate markers of cardiovascular outcome, but in the recently published <jats:styled-content style="fixed-case">SERVE‐HF</jats:styled-content> randomized trial, <jats:styled-content style="fixed-case">ASV</jats:styled-content> was associated with significantly increased mortality and no improvement in <jats:styled-content style="fixed-case">HF</jats:styled-content> hospitalization or quality of life. Further research is needed to clarify the therapeutic rationale for the treatment of <jats:styled-content style="fixed-case">CSA</jats:styled-content> in <jats:styled-content style="fixed-case">HF</jats:styled-content>. Cardiologists should have a high index of suspicion for sleep‐disordered breathing in those with <jats:styled-content style="fixed-case">HF</jats:styled-content>, and work closely with sleep physicians to optimize patient management.</jats:p>