Continuous Positive Airway Pressure in Patients With Congestive Heart Failure and Cheyne-Stokes Respiration With Central Sleep Apnea

To the Editor: The article by Sin et al1 on the effect and outcome of continuous positive airway pressure (CPAP) in patients with congestive heart failure (CHF) who have Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is one more step toward further defining the role of treatment for sleep-disordered breathing in CHF. The authors conclude that CPAP improves short-term left ventricular ejection fraction (LVEF) and may improve mortality and transplant-free survival in patients with CSR-CSA but not in patients without it. A few features of the study merit further observation.The authors demonstrated a statistically significant improvement in LVEF at 3 months, but they did not establish that the initial benefit was sustained. Repeat measurements of LVEF at 18 months (the mean long-term follow-up period) would have been useful. This would further corroborate the observed trend toward improved mortality and transplant-free survival. In this study, all the patients with CSR-CSA who were compliant with CPAP benefited in terms of the above …