This case revealed a patient with a history of OSA before the onset of chronic heart failure.  At this point the patient had persistent CSA with CSR on CPAP and also predominant CSA with CSR on room air.  However, since this patient had heart failure with a reduced LVEF, the question remains how to treat this patient, since the results of the SERVE-HF (Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) trial^[3] revealed a potentially deleterious effect of PAP in patients with predominant CSA and with chronic heart failure and LVEF <45%. 

So the question for discussion is: should we maintain ASV therapy in this patient or should we not?