Cheyne–Stokes respiration detected via CPAP devices as a digital biomarker for heart failure in obstructive sleep apnoea: systematic review

Abstract Study Objectives To synthesize evidence on the diagnostic, prognostic, surveillance, and monitoring potential of Cheyne–Stokes respiration (CSR) ventilatory patterns, as detected by continuous positive airway pressure (CPAP) devices, in patients with heart failure (HF) or at risk of HF—often with comorbid obstructive sleep apnoea. Materials and Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. Five electronic databases were searched (1946–2025) for studies examining CSR derived from CPAP airflow signals (CPAP-CSR), and heart-failure outcomes. Data synthesis followed Synthesis Without Meta-analysis guidelines across five domains: presence, burden, morphology, temporal dynamics, and aetiology. Results Five studies were included. CPAP-CSR presence was strongly associated with serious cardiac events (adjusted OR 5.74; p < .001) at 12 months. CPAP-CSR burden correlated with [B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR)], HF hospitalisations, and serious cardiac events. Morphological features, specifically longer cycle lengths (˃68.9 s), accurately discriminated HF-related CSR (AUC 0.954). Short-term temporal dynamics were highly prognostic; day-to-day instability (SD-CSB%) predicted acute HF decompensation (AUC 0.919), reflecting an inability to maintain normal function. Aetiological stratification revealed that progressive CPAP-CSR burden and serious cardiac events occurred exclusively in the cardiovascular-related CSR subgroups. Conclusions CPAP-CSR is consistently associated with heart-failure status and its temporal changes, highlighting its potential as a non-invasive biomarker for disease presence and progression.