TABLE VII.A.6b.

Guidelines for testing and treatment of OSA in hFrEF

Author	Question	Statement	Class	Level of evidence
AHA/ACC/HFSA	Should people with	A formal sleep assessment	IIa (moderate	C-LD (Limited data,
Guidelines on Management of Heart Failure753	hFrEF be tested for OSA?	is reasonable for people with suspicion of SDB or EDS	recommendation)	randomized or non-randomized observational, or registry studies with limitations of design or execution, meta-analyses of such studies, physiological, or mechanistic studies in human subjects)
	Should Patients with hFrEF and OSA be treated with CPAP?	In patients with CVD and OSA, CPAP may be reasonable to improve sleep quality and daytime sleepiness	IIb (weak recommendation)	B-R (moderate quality evidence from one or more RCTs/meta-analysis of moderate quality RCTs)
AASM Guidelines for Evaluation and management of OSA513; AASM Clinical Practice Guideline for OSA572; AASM guidelines for treatment of adult OSA with PAP39	Who should be evaluated for OSA?	Patients with comorbidities considered “high risk” for OSA including HF	N/A	N/A
	Where should patients with suspected OSA and significant comorbidities (including HF) be tested?	Consider initiating PAP using an in-lab strategy	Strong Recommendation	N/A
	Should PAP be recommended or withheld in non-sleepy OSA patients to reduce cardiovascular events or mortality?	Insufficient evidence	No recommendation	N/A
	Initiation of PAP therapy	In patients with significant comorbidities, PAP initiation using an in-lab strategy should be considered	N/A	N/A

Abbreviations: AASM, American Academy of Sleep Medicine; ACC, American College of Cardiology; AHA, American Heart Association; ASV, adaptive servoventilation; CSA, central sleep apnea; CVD, cardiovascular disease; EDS, excessive daytime sleepiness; HFSA, Heart Failure Society of America; NYHA, New York Heart Association; PAP, positive airway pressure; SDB, sleep-disordered breathing.