Congestive heart failure (CHF) is a disorder associated with an increasing prevalence and a mortality greater than many malignancies.1 Its prevalence has doubled in the last 20 years2 mainly as a result of improved myocardial infarction survival.3 In terms of mortality, over 50% of patients diagnosed with CHF today will be dead in five years.1 Unfortunately, despite advances in medical treatments—in particular angiotensin converting enzyme inhibitors—survival has improved only marginally.4Whether β adrenergic blockers offer a true survival benefit is currently debated.5 ,6 Clearly, other therapeutic modalities need to be developed.

This brief review discusses the role of sleep apnoea and its reversal with continuous positive airway pressure (CPAP) in patients with CHF. Discussion will focus initially upon the rationale for CPAP in acute unstable and chronic stable CHF. Thereafter, the influence of long term treatments of sleep apnoea (CPAP and other treatments) on cardiac function in patients with chronic CHF will be discussed.

As early as 1936 positive airway pressure was used to treat acute cardiogenic pulmonary oedema.7 Since then, many clinicians have reported improvements in cardiopulmonary physiology such as arterial blood gas tensions and work of breathing in patients with acute cardiogenic pulmonary oedema who were mechanically ventilated with positive end expiratory pressure (PEEP).8 Similar reports were observed in patients with cardiogenic pulmonary oedema breathing spontaneously with CPAP9-11 compared with standard medical treatment alone. Moreover, CPAP delivered via an oronasal or nasal mask has been shown to reduce the need for tracheal intubation and invasive ventilation, to reduce the length of stay in intensive care, and has a tendency for increased in-hospital survival in patients with acute decompensated CHF compared with medical treatment alone.10 In patients with stable CHF short term CPAP may also have a beneficial …