Current treatment approaches and trials in central sleep apnea

• Central sleep apnea affects many cardiovascular patients, especially those with heart failure with reduced ejection fraction.
• CSA results in cycles of hypoxia and nor-epinephrine release which have significant negative consequences in heart failure patients.
• Treatment of CSA has focused on positive airway pressure therapies, but recent trials did not demonstrate improvement in morbidity and mortality.
• Importantly, recent trials have raised concern for harm with certain positive pressure modalities in patients with heart failure and CSA Additional studies are needed to understand the subtypes of CSA and to individualize the treatment approach.

Central sleep apnea (CSA) is one of the most common comorbidities in patients with heart failure with reduced ejection fraction and is associated with negative consequences. Despite several recent advances, there are currently no widely accepted therapies for CSA. In this review we will discuss available therapies for CSA and review the published trials addressing treatment of CSA in HFrEF patients.