Per standard practice, the patient was treated with cardiac optimization, meaning his beta-blocker dose was increased, he was put on an appropriate dose of aldosterone inhibitor, his ACE inhibitor was changed to an angiotensin receptor blocker (ARB), and he was implanted with a cardiac resynchronization therapy device with implantable cardioverter defibrillator (CRT-D).  When this patient was referred to the sleep lab he was screened for the possibility that a sleep apnea syndrome was aggravating his heart failure.  He was not sleepy (assessed by the Pichot scale of fatigue), quite depressed (measured with the Pichot depression scale), and his quality of life (assessed with the Minnesota Living with Heart Failure Questionnaire, MLHFQ), was quite high.