Should We Let Sleeping Dogs Lie? Controversies of Treating Central Sleep Apnoea in HFrEF Following the SERVE-HF Study

Central sleep apnoea (CSA) is common in patients with heart failure (HF), with a prevalence of 20–45 %. It is a marker of severity of HF and is independently associated with increased morbidity and mortality rates in patients with HF. Targeting CSA with adaptive servoventilation (ASV) was postulated to improve outcomes; however, the results of the recent SERVE-HF (Treatment of Sleep-disordered Breathing by Adaptive Servo-ventilation in Heart Failure Patients) trial showed that in patients with CSA and HF with reduced ejection fraction (HFrEF), ASV, despite successfully treating CSA, was associated with increased risk of cardiovascular death compared with medical therapy. In this expert opinion we discuss the controversies of treating CSA in HFrEF following the SERVE-HF study.