Central Sleep Apnea Treatment Guidelines

The American Academy of Sleep Medicine recommends that ASV should NOT be used for CSA related to CHF in adults with an ejection fraction ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing due to increased risk of death 1
For patients with CSA related to heart failure and an ejection fraction > 45%, ASV can be considered if CPAP fails, with close monitoring and follow-up 1
The American Academy of Sleep Medicine suggests that if EF ≤ 45%, CPAP or low-flow oxygen should be used, and ASV should not be used 1

Treatment Algorithm and Monitoring

Treatment with ASV in patients with heart failure requires close monitoring and follow-up, as recommended by the American Academy of Sleep Medicine 1
The American Academy of Sleep Medicine advises against using ASV in heart failure patients with reduced ejection fraction (≤45%), which increases mortality risk 1

The American College of Cardiology recommends that VAPS therapy should not be used for central sleep apnea in patients with heart failure with reduced ejection fraction (≤45%) due to increased mortality risk, but may be considered in other forms of central sleep apnea after careful patient selection 2, 3
ASV/VAPS is contraindicated in patients with heart failure with reduced ejection fraction (HFrEF) ≤45% and moderate-to-severe CSA due to increased cardiovascular mortality demonstrated in the SERVE-HF trial 2, 3

ASV/VAPS therapy has been shown to increase all-cause and cardiovascular mortality in HFrEF patients despite reducing AHI 3