{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:36:45Z","timestamp":1760060205489,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Obstructive sleep apnea (OSA) is a common comorbidity in patients with cardiac and metabolic disorders. The coexistence of central sleep apnea with Cheyne\u2013Stokes breathing (CSA-CSB) in heart failure patients, especially those with preserved ejection fraction (HFpEF), represents a diagnostic and therapeutic challenge. Data on continuous positive airway pressure (CPAP) failure and successful adaptation to servo-ventilation (ASV) in the context of complex comorbidities remain limited. Case Presentation: We present the case of a 74-year-old male with a history of type 2 diabetes mellitus, paroxysmal atrial fibrillation, HFpEF, essential hypertension, and bladder carcinoma. He was referred for pre-operative OSA screening, reporting excessive daytime sleepiness, insomnia, and witnessed apneas. Initial respiratory polygraphy revealed severe sleep-disordered breathing with dominant CSA-CSB and moderate OSA. Laboratory investigations also revealed severe iron-deficiency anemia, which was managed with parenteral iron supplementation. The patient underwent CPAP titration, which led to modest improvement and residual high apnea\u2013hypopnea index (AHI). After persistent symptoms and an inadequate CPAP response, an ASV device was initiated with significant clinical and respiratory improvement, demonstrating normalization of hypoxic burden and optimal adherence. Conclusions: CSA-CSB in HFpEF patients with anemia poses unique therapeutic difficulties. This case highlights the importance of individualized diagnostic and therapeutic strategies, including transitioning to ASV in CPAP-refractory cases, which can lead to improved adherence, reduced hypoxia, and better overall outcomes in high-risk patients.<\/jats:p>","DOI":"10.3390\/reports8030140","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T08:33:06Z","timestamp":1754555586000},"page":"140","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adaptive Servo-Ventilation for Central Sleep Apnea in an Anemic Patient with Cardiac Disease: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1879-9856","authenticated-orcid":false,"given":"Bianca","family":"Domokos-Gergely","sequence":"first","affiliation":[{"name":"\u201cLeon Daniello\u201d Clinical Hospital of Pneumophysiology, 400371 Cluj-Napoca, Romania"},{"name":"Department of Medical Sciences\u2014Pulmonology, Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel-Flaviu","family":"Bri\u0219an","sequence":"additional","affiliation":[{"name":"\u201cLeon Daniello\u201d Clinical Hospital of Pneumophysiology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1306-2350","authenticated-orcid":false,"given":"Doina","family":"Todea","sequence":"additional","affiliation":[{"name":"\u201cLeon Daniello\u201d Clinical Hospital of Pneumophysiology, 400371 Cluj-Napoca, Romania"},{"name":"Department of Medical Sciences\u2014Pulmonology, Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"ref_1","first-page":"2101640","article-title":"Sleep apnoea and heart failure","volume":"59","author":"Naughton","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1600959","DOI":"10.1183\/13993003.00959-2016","article-title":"Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep","volume":"49","author":"Randerath","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"230235","DOI":"10.1183\/20734735.0235-2023","article-title":"Management of central sleep apnoea: A review of non-hypercapnic causes","volume":"20","author":"Zheng","year":"2024","journal-title":"Breathe"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1080\/17476348.2019.1604226","article-title":"Diagnosis and management of central sleep apnea syndrome","volume":"13","author":"Baillieul","year":"2019","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_5","first-page":"164","article-title":"Sleep-disordered breathing in patients with atrial fibrillation and normal systolic left ventricular function","volume":"106","author":"Bitter","year":"2009","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jacep.2015.02.014","article-title":"Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis","volume":"1","author":"Shukla","year":"2015","journal-title":"JACC Clin Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107820","DOI":"10.1016\/j.rmed.2024.107820","article-title":"Deciphering Loop Gain complexity: A primer for understanding a pathophysiological trait of Obstructive Sleep Apnea patients","volume":"234","author":"Antonaglia","year":"2024","journal-title":"Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.ahj.2007.07.034","article-title":"Improvement of anemia with erythropoietin and intravenous iron reduces sleep-related breathing disorders and improves daytime sleepiness in anemic patients with congestive heart failure","volume":"154","author":"Zilberman","year":"2007","journal-title":"Am. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1172\/JCI107945","article-title":"The effect of anemia on the ventilatory response to transient and steady-state hypoxia","volume":"55","author":"Santiago","year":"1975","journal-title":"J. Clin. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1093\/sleep\/29.8.1045","article-title":"Lateral sleeping position reduces severity of central sleep apnea\/Cheyne-Stokes respiration","volume":"29","author":"Szollosi","year":"2006","journal-title":"Sleep"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.5664\/jcsm.27772","article-title":"Comorbid insomnia and obstructive sleep apnea: Challenges for clinical practice and research","volume":"6","author":"Luyster","year":"2010","journal-title":"J. Clin. Sleep Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2300828","DOI":"10.1183\/13993003.00828-2023","article-title":"Hypoxic burden to guide CPAP treatment allocation in patients with obstructive sleep apnoea: A post hoc study of the ISAACC trial","volume":"62","author":"Pinilla","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/eurheartj\/ehy624","article-title":"The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: The Osteoporotic Fractures in Men Study and the Sleep Heart Health Study","volume":"40","author":"Azarbarzin","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_14","first-page":"36","article-title":"Hypoxic Burden in Obstructive Sleep Apnea: Present and Future","volume":"59","author":"White","year":"2022","journal-title":"Arch. Bronconeumol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Thomas, R.J., Bhat, S., and Chokroverty, S. (2023). Atlas of Sleep Medicine, Springer. [3rd ed.].","DOI":"10.1007\/978-3-031-34625-5"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S2213-2600(23)00374-0","article-title":"Adaptive servo-ventilation for sleep-disordered breathing in patients with heart failure with reduced ejection fraction (ADVENT-HF): A multicentre, multinational, parallel-group, open-label, phase 3 randomised controlled trial","volume":"12","author":"Bradley","year":"2024","journal-title":"Lancet Respir. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.hrtlng.2021.01.012","article-title":"Therapeutic value of treating central sleep apnea by adaptive servo-ventilation in patients with heart failure: A systematic review and meta-analysis","volume":"50","author":"Wang","year":"2021","journal-title":"Heart Lung"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1056\/NEJMoa1506459","article-title":"Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure","volume":"373","author":"Cowie","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.eclinm.2019.06.011","article-title":"Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia","volume":"13","author":"Krakow","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"111144","DOI":"10.1016\/j.jclinane.2023.111144","article-title":"The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis","volume":"88","author":"Ruan","year":"2023","journal-title":"J. Clin. 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