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Central sleep apnoea in heart failure — SCE Respiratory MCQ

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HardSleep medicineCentral sleep apnoea in heart failureSCE Respiratory

A 70-year-old man with heart failure with reduced ejection fraction reports witnessed cyclical apnoeas and nocturnal dyspnoea. Sleep study shows central apnoea index 34/hour with crescendo-decrescendo ventilation. Left ventricular ejection fraction is 28%, and he is not excessively obese. He asks whether adaptive servo-ventilation should be started. What is the most appropriate management?

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Correct answer: D — Optimise heart failure therapy and avoid adaptive servo-ventilation

Central sleep apnoea with Cheyne-Stokes respiration occurs in heart failure, and adaptive servo-ventilation is avoided in reduced ejection fraction because of safety concerns. Treating it as simple OSA misses the central pattern and cardiac substrate. Optimising heart failure therapy is the priority before considering specialist sleep interventions.

Reference: ERS sleep-disordered breathing guidance; NICE chronic heart failure guidance