The Intersection of Cardiology and Sleep Medicine: Impact of Sleep-Disordered Breathing on Heart Failure Outcomes

Sleep-disordered breathing (SDB)—including obstructive sleep apnea (OSA) and central sleep apnea (CSA)—is highly prevalent among individuals with heart failure (HF), yet frequently underdiagnosed. Increasing evidence shows that SDB and HF interact in a vicious cycle: recurrent hypoxic episodes, fluctuations in intrathoracic pressure, and autonomic dysregulation further strain cardiac function, while HF itself predisposes to the development of apnea. This interplay worsens arrhythmia burden, symptom severity, and long-term prognosis. This review will explore how OSA and CSA influence HF progression and outcomes, elucidate the underlying mechanisms linking these conditions, and discuss diagnostic challenges—from simple screening questionnaires to advanced telemonitoring approaches. We will critically evaluate current therapeutic options, including continuous positive airway pressure (CPAP), adaptive servo-ventilation (ASV), and emerging technologies, in light of major clinical trials and guideline recommendations. Finally, we will highlight the importance of a multidisciplinary, patient-centered approach to improve outcomes in this complex patient population.