Central apnea and specifically Cheyne-Stokes respiration represents a very common phenomenon in the context of systolic heart failure (HF) and has been associated with several neurohormonal and hemodynamic alterations that connote a negative clinical profile that ultimately leads to adverse prognosis. However, the negative consequences of the treatments proposed so far to tackle this phenomenon have raised concerns about the real connotation of central apnea in the context of systolic HF, specifically, whether CSR represent a neutral phenomenon or even a compensatory one.