Cheyne-Stokes respiration with central sleep apnoea in chronic heart failure: proposals for a diagnostic and therapeutic strategy.

Central sleep apnoea (CSA) is highly prevalent in the evolutionary course of chronic heart failure. Such a ventilatory pattern during sleep is independently associated with poor prognosis in people with congestive heart failure. Chronic hyperventilation and daytime hypocapnia are the main mechanisms underlying the frequent association between CSA and cardiac failure. Simplified diagnostic strategies allowing easier recognition of CSA among people with severe heart failure are obviously needed but remain to be validated. Treatment of CSA is essentially aimed at improving cardiac function. When CSA persists, after appropriate adjustment of medication and resynchronisation therapy when indicated, specific ventilatory support during sleep should be considered. Continuous positive airway pressure (CPAP), oxygen, adaptive Servo-ventilation (ASV) and non-invasive ventilation have been proposed. Large randomised trials demonstrating survival and time free from heart transplantation are lacking.