Central Sleep Apnea: An Update of Current Treatment and the Role of Positive Pressure Devices

Central sleep apnea (CSA) is associated with increased mortality, particularly in heart failure. This review discusses current treatment options with a focus on different positive airway pressure (PAP) modalities, the clinical implication of continuous PAP (CPAP) failure, and key advancements in adaptive servo-ventilation (ASV). CPAP reduces CSA by about 50% in patients with heart failure with reduced ejection fraction. The remaining patients are considered non-responsive and chronic use of CPAP has been associated with excess mortality. ASV is effective in several forms of CSA. While secondary analyses of the SERVE-HF trial limited its use in patients with predominant CSA and left ventricular ejection fraction < 45%, more recent data from ADVENT-HF using a newer ASV generation targeting peak flow has shown promising results. Physicians should consider the underlying pathophysiology, overall prognosis, and evidence base prior to selecting CSA treatment with CPAP or ASV. Promising pharmaceutical and novel device options require more studies and long-term evidence.