Cheyne-Stokes respiration in patients with heart failure: ominous sign or innocent bystander?

Cheyne-Stokes respiration (CSR) during the day and at night is common in patients with severe heart failure. CSR harms the failing heart through recurrent sympathetic overstimulation caused by sleep disturbances and intermittent hypoxia brought about by apnoea and hypopnoea. CSR impairs patients' quality of life and wakefulness, and probably also increases cardiac mortality in patients with heart failure. Thus, CSR should be actively sought in patients with a left ventricular ejection fraction <40%. When CSR persists despite optimal drug therapy for heart failure, non-invasive ventilation, particularly as adaptive servoventilation, and cardiac resynchronisation therapy are currently the most promising treatment options.