Positive Airway Pressure for Sleep-Related Breathing Disorders in Heart Failure—Overview and Discussion of Potential Mechanisms of Harm

Purpose of Review: The impact of positive airway pressure (PAP) therapies on cardiovascular outcome in obstructive sleep apnea (OSA) and central sleep apnea (CSA) is currently under debate. The goal of this review is to critically analyze the current findings and discuss hypotheses on benefits or even harm in patients with heart failure (HF). Recent Findings: While PAP sufficiently improves OSA, symptoms and cardiac parameters, the SAVE trial failed to show survival benefits. However, it was limited due to low adherence, non-sleepy population and maximal cardiac pre-treatment. SERVE-HF showed increased mortality in secondary analysis in patients with severe systolic HF with predominant CSA under adaptive servo-ventilation (ASV). Criticism of the trial emanated from high crossover, low compliance, use of older devices, and contradictory beneficial results in other studies. As sudden cardiac deaths was the reported main cause of mortality, influences of pre-medication and methods of pressure support on cardiac instability may have contributed to the pathogenesis. Summary: OSA and CSA are main risk factors for poor outcome in cardiovascular disease. However, the effect of CPAP and ASV on cardiovascular comorbidities and prognosis requires further evaluation. Further insights from ongoing trials are urgently needed to clarify benefits and risk. © 2018, Springer International Publishing AG, part of Springer Nature.