Sleep apnea in patients with heart failure: could cardiac resynchronization therapy be the first line treatment?

Adaptive servo-ventilation as well as continuous and bi-level positive airway pressure seems to effectively treat sleep apnea syndrome (SAS) in patients with chronic heart failure (CHF), and to improve left ventricular function. However, no randomized data show a significant impact of ventilation on survival in patients with CHF. By contrast, there is overwhelming evidence that cardiac resynchronization therapy (CRT) improves outcomes in patients with CHF. CRT also provides a clinically significant decrease in SAS severity in patients with CHF. Consequently, CRT eligibility criteria should always be searched for in patients with severe CHF having SAS.