Positive Airway Pressure Therapies for Heart Failure: What Do the Trials Tell Us?

Sleep-disordered breathing (SDB) represents a modifiable treatment target in patients with heart failure (HF). Despite the evolution of positive airway pressure (PAP) therapy over the past several decades, randomised controlled trials have not demonstrated a consistent benefit in reducing mortality or hospital admissions related to HF. As a result, the use of PAP therapy has been primarily limited to symptom control of SDB. However, recent trials suggest that PAP therapy is safer than previously perceived and underscore an urgent need for a phenotype-based, individualised treatment approach. Stratifying patients according to sleep apnoea phenotypes or characteristic clinical clusters may enhance the identification of individuals most likely to respond favourably to PAP therapy in terms of clinical outcomes. This narrative review provides an outline of the current evidence regarding the use of PAP therapy in patients with SDB across the spectrum of HF phenotypes.