Central sleep apnea/Hunter-Cheyne-Stokes Breathing (CSA/HCSB), is prevalent in patients with heart failure with reduced ejection fraction (HFrEF). The acute pathobiological consequences of CSA/HSCB eventually lead to sustained sympathetic over-activity, repeated hospitalization, and premature mortality. Few small randomized controlled trials (RCTs) have shown statistically significant and clinically important reduction in sympathetic activity when CSA/HCSB is attenuated by oxygen or positive airway pressure (PAP) therapy, both continuous PAP (CPAP) and Adaptive servo ventilation (ASV) devices. Yet, the two largest PAP trials in patients with HFrEF, one with CPAP and the other with an ASV, were negative with respect to their primary outcomes, and both associated with excess mortality. However, both trials suffered from significant deficiencies casting doubt on their results. A second RCT evaluating an ASV device with advanced algorithm is ongoing. A new modality of therapy, unilateral phrenic nerve stimulation, has undergone an RCT that demonstrated an improvement in CSA that was associated with a reduction in arousals, improvement in sleepiness and quality of life. However, a long-term mortality trial has not been performed with this modality. Most recently, the NIH funded a long-term, phase-III RCT of low flow oxygen vs. sham for the treatment of CSA/HCSB in HFrEF. The composite primary outcome includes all-cause mortality and hospitalization for worsening HF. In this article, we focus on various therapeutic options for the treatment of CSA/HCSB and, when appropriate, emphasize the importance of identifying CSA/HCSB phenotypes to tailor treatment.

中文翻译：

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射血分数降低心力衰竭呼吸暂停的最新进展：强调治疗的生理学第 2 部分：中枢性睡眠呼吸暂停

中枢性睡眠呼吸暂停/亨特-夏恩-斯托克斯呼吸 (CSA/HCSB) 在射血分数降低的心力衰竭 (HFrEF) 患者中很普遍。CSA/HSCB 的急性病理生物学后果最终导致持续的交感神经过度活动、反复住院和过早死亡。很少有小型随机对照试验 (RCT) 显示，当 CSA/HCSB 通过氧气或气道正压 (PAP) 治疗（连续 PAP (CPAP) 和自适应伺服通气 (ASV) 装置减弱时，交感神经活动有统计学意义和临床意义的降低） . 然而，针对 HFrEF 患者的两项最大的 PAP 试验（一项为 CPAP，另一项为 ASV）的主要结局均呈阴性，且均与死亡率过高相关。然而，两项试验都存在重大缺陷，令人对其结果产生怀疑。使用高级算法评估 ASV 设备的第二项 RCT 正在进行中。一种新的治疗方式，单侧膈神经刺激，已经进行了一项 RCT，证明 CSA 的改善与唤醒减少、嗜睡和生活质量的改善有关。然而，尚未使用这种方式进行长期死亡率试验。最近，NIH 资助了一项长期的 III 期 RCT，将低流量氧气与假手术用于治疗 HFrEF 中的 CSA/HCSB。复合主要结局包括全因死亡率和因心衰恶化而住院。在本文中，我们重点介绍治疗 CSA/HCSB 的各种治疗选择，并在适当的时候，