Cheyne-Stokes respiration (CSR) with central sleep apnea (CSA) [CSR-CSA] is a breathing disorder seen in patients with advanced congestive heart failure (CHF) that is characterized by the presence of central apneas and hypopneas, alternating with periods of crescendo-decrescendo tidal volume.1–
CSR-CSA has been associated, in a severity-dependent manner, with elevations of sympathetic nervous activity in CHF patients,2–
which is an important predictor of CHF progression, arrhythmias, and mortality.3–4
Indeed, CSR-CSA, independent of other risk factors, elevates the risk of mortality in CHF by twofold to threefold.5
Successful treatment of CSR by continuous positive airway pressure (CPAP) leads to a significant reduction in sympathetic nervous activity2
and may reduce mortality rates by up to 40% in patients with CHF and CSR-CSA.6
Since CPAP has salutary effects on cardiac function (independent of its effect on CSR), it remains uncertain whether CSR-CSA is a mere epiphenomenon of a failing heart or a major contributor of poor outcomes of patients with CHF.