The 2025 American Academy of Sleep Medicine Central Sleep Apnoea Guidelines and the Heart Failure Patient.

Abstract

Central sleep apnoea (CSA) and Cheyne-Stokes respiration are prevalent in patients with heart failure and contribute to disease progression, increased risk of death, heart failure hospitalisations and reduced quality of life. The 2025 American Academy of Sleep Medicine Clinical Practice Guideline for the Treatment of Central Sleep Apnea in Adults represents a major advance, recognising transvenous phrenic nerve stimulation as an evidence-based therapy for adults with CSA, including those with heart failure, as well as updating the clinical data on adaptive servo-ventilation. This review summarises key updates in the American Academy of Sleep Medicine 2025 guideline, examines the pathophysiological link between CSA and heart failure, and evaluates the clinical evidence and practical considerations for treatment. Current evidence indicates improvements in apnoea indices, oxygenation and quality of life, while the effect on mortality and hospitalisation needs additional prospective randomised data. Identification of patients with signs and symptoms which are likely due to central sleep apnoea is often missed in clinical practice, and treatment has a significant impact on quality of life.