Central sleep apnoea (CSA) with Cheyne-Stokes breathing — a periodic breathing pattern with cyclically waxing and waning respiratory effort — is a recognised complication of heart failure with reduced ejection fraction (HFrEF). The approach to management in this setting is shaped by the underlying cardiac dysfunction.
CSA with concurrent Cheyne-Stokes breathing is observed in low cardiac output states, including heart failure with reduced ejection fraction. This protocol applies when the left ventricular ejection fraction is below 45% — a threshold that substantially influences which interventions are appropriate and which are not.
The primary therapeutic focus is optimisation of the underlying heart failure itself. Certain established classes of heart failure therapy have been shown to improve CSA alongside other clinical outcomes, including cardiac function and quality of life.
In a specific subset of patients with ventricular conduction abnormalities, a device-based cardiac intervention may provide additional benefit. The full sequencing and specific components of the regimen are set out in the complete protocol.
Full agent selection, sequencing, and further management considerations are available in the complete structured regimen below.
DOI: 10.1183/20734735.0235-2023