Cheyne-Stokes Respiration Detected via CPAP Devices as a Digital Biomarker for Heart Failure in Obstructive Sleep Apnoea: Systematic Review

ABSTRACT Study Objectives To synthesise 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 (OSA). 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 (SWiM) 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 0.001). 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 (SCE). Morphological features, specifically longer cycle lengths (˃68.9s), 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 (CVD-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.