• sleep apnoea

Over the last decade, results from cluster analyses have offered new insights into pathophysiological endotypes of obstructive sleep apnoea (OSA), opening the possibility to developing a more personalised approach to OSA treatment. In contrast, therapeutic approach to patients with heart failure (HF) and central sleep apnoea (CSA) remains quite undifferentiated. If optimisation of the underlying HF fails to improve CSA, continuous positive airway pressure might be offered in the majority of symptomatic patients. While adaptive servoventilation (ASV) has been developed suppressing CSA and Cheyne-Stokes respiration/periodic breathing, its use is limited to patients without HF or to those with preserved left ventricular ejection fraction of >45%. The data of the French Cohort Study of Chronic Heart Failure Patients With Central Sleep Apnoea Eligible for Adaptive Servo-Ventilation (FACE) trial1 add important puzzle pieces to our understanding of the outcome of patients with HF with CSA, thus fostering a more differentiated perspective to treatment and supporting the concepts of tailoring treatment to individual patients:

1. FACE includes patients who are typically excluded from randomised controlled trials due to their characteristics.

2. It raises the question of specific phenotypes with unfavourable outcome.

The Treatment of Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure (SERVE-HF) trial2 studied a specific HF population with predominant CSA and left ventricular ejection fraction ≤45%. The FACE trial, which enrolled patients from 2009 to 2018,1 included patients who were prescribed ASV before and after publication of the SERVE-HF …