Central sleep apnoea (CSA) with Cheyne-Stokes breathing (CSB) is a recognised complication of heart failure with preserved ejection fraction (HFpEF; left ventricular ejection fraction >45%). When first-line therapy does not achieve adequate control, a structured next-line intervention is indicated.
CSA with concurrent CSB — a form of periodic breathing characterised by waxing and waning amplitude of flow and tidal volume — can occur in low cardiac output states including HFpEF, where impaired cardiac filling and relaxation drive the periodic breathing pattern. Left ventricular ejection fraction above 45% defines this sub-population.
This protocol applies when continuous positive airway pressure (CPAP) therapy, with or without supplemental oxygen, has not adequately controlled CSA. The specific target that triggers escalation to this line is failure to reduce the apnoea-hypopnoea index to below 15 events per hour.
In HFpEF with CPAP-refractory CSA–CSB, a specific positive pressure ventilation modality is among the options to consider. The complete protocol — including initiation criteria, titration approach, and monitoring requirements — is available via the link below.
DOI: 10.1183/20734735.0235-2023
CSA, often with concurrent CSB (a form of periodic breathing with waxing and waning amplitude of flow/tidal volume), can be observed in low cardiac output states including heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF; impaired cardiac filling/relaxation) and cardiac arrhythmia.
In HFpEF, ASV can still be considered in instances of CPAP failure to treat CSA–CSB.
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