The patient was treated with cardiac optimization, including optimally dosed beta-blocker, aldosterone blockade, an angiotensin receptor blocker (ARB), and implantation of a cardiac resynchronization therapy device with implantable cardioverter defibrillator (CRT-D) device.  After 6 months his heart failure was NYHA class III with an LVEF of 30%.  At this point he was referred to a sleep physician because he was having a problem continuing CPAP due to intolerance, with progressively less adherence to CPAP every night.