How do you manage patients with central sleep apnea due to heart failure with reduced ejection fraction?

I assume you are referring to CSA with Cheyne-Stokes respiration. Several possibilities, but first ask yourself what your treatment goal is.

If the patient does NOT have symptoms (frequent awakenings, daytime sleepiness, etc.) I contend that you don't need to treat at all. We already know that there are patients with HFREF who might be harmed with ASV (SERVE-HF). Even if one thinks that the recent ADVENT-HF trial lays the harm signal to rest (debatable) there was still no clear *benefit* to ASV in CSA with HFREF. We can conclude that CSA in this population is a marker of poor cardiac function, but a mediator of harm. The jury is out.

If the patient has poor sleep quality/daytime sleepiness, or some other clinically important finding then it ...