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CPAP for OSA in Heart Failure — EECC MCQ

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ModerateHeart FailureCPAP for OSA in Heart FailureEECC

A 70-year-old man with HFrEF and sleep-disordered breathing is diagnosed with obstructive sleep apnoea (OSA) on polysomnography (AHI 35/hour). What treatment is recommended?

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Correct answer: C — CPAP therapy — OSA contributes to HF progression through sympathetic activation, hypoxia, and negative intrathoracic pressure swings; CPAP improves symptoms, LVEF, and quality of life in HF patients with OSA

In HF patients with OSA, CPAP (continuous positive airway pressure) is recommended to: (1) improve oxygenation and reduce hypoxic pulmonary vasoconstriction; (2) reduce sympathetic activation (which worsens HF); (3) eliminate the negative intrathoracic pressure swings during obstructive events (which increase LV afterload and wall stress); (4) improve LVEF (modest improvement demonstrated in studies). Importantly, CPAP is recommended for OSA in HF, while ASV is CONTRAINDICATED for central sleep apnoea in HFrEF (SERVE-HF showed increased mortality). This distinction between OSA (treat with CPAP) and CSA (do NOT treat with ASV in HFrEF) is critical. Weight loss, positional therapy, and mandibular advancement devices may also help in OSA.

Reference: ESC (2023): HF Guidelines