Background Orthopnoea and paroxysmal nocturnal dyspnoea are common entities regularly confronting thoracic physicians, particularly those with an interest in sleep medicine or non-invasive ventilatory support. One major cause is heart failure (HF), usually associated with abnormal lung function tests, and either obstructive or central sleep apnoea with Cheyne–Stokes respiration (CSA–CSR). Whereas obstructive apnoea is considered injurious to the cardiovascular system, the effects of CSA–CSR are less clear and may be a compensatory response to severe HF.

Aim To determine whether there are compensatory or possibly beneficial aspects caused by CSA–CSR in HF.

Methods Literature review.

Results CSA–CSR can be detrimental in terms of intermittent hypoxaemia, arousals and autonomic dysregulation. However, it is also associated with the beneficial effects of hyperventilation-related increases in end-expiratory lung volume, intrinsic positive airway pressure, assistance to stroke volume, attenuation of excessive sympathetic nervous activity, avoidance of hypercapnic acidosis and finally the provision of periodic rest to fatigue-prone respiratory pump muscles.

Conclusions CSA–CSR has physiological features more likely to be compensatory and beneficial than injurious in HF. Some aspects of CSA–CSR are similar to those seen with positive airway pressure.