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Central sleep apnoea in heart failure: one size does not fit all
  1. Winfried J Randerath1,
  2. Michael Arzt2
  1. 1 Department of Pneumology, Bethanien Hospital, Solingen, Nordrhein-Westfalen, Germany
  2. 2 Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
  1. Correspondence to Professor Michael Arzt, Innere Medizin II, Universitätsklinikum Regensburg, 93053 Regensburg, Bayern, Germany; michael.arzt{at}

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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 …

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  • WJR and MA contributed equally.

  • Contributors Both authors added equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MA has received consulting fees from ResMed, Philips Respironics, Boehringer Ingelheim, NRI, Novartis, JAZZ Pharmaceuticals, Bayer, Inspire and Bresotec, and grant support from ResMed Foundation, ResMed, Philips Respironics and Else-Kroehner Fresenius Foundation (2018_A159), outside the submitted work. WJR has received consulting fees from Philips respironics, Jazz Pharmaceuticals and Bioprojet and honoraria from Weinmann, Heinen & Löwenstein, Bioprojet, Philips Respironics, Jazz Pharmaceuticals and support for attending meetings from Heinen & Löwenstein, Inspire, Philips Respironics, Bioprojet.

  • Provenance and peer review Commissioned; externally peer reviewed.

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