Background: Continuous Positive Airway Pressure (CPAP) therapy is commonly used to manage sleep-disordered breathing in heart failure patients, but adherence remains a challenge. Respiratory therapists (RTs) play a crucial role in optimizing CPAP therapy, yet the impact of their involvement on patient outcomes has not been thoroughly examined.Objective: This study investigates the effectiveness of CPAP therapy in heart failure patients, focusing on the role of respiratory therapists in implementing and monitoring the therapy.Methods: A retrospective cohort study was conducted in a large tertiary care hospital, comparing heart failure patients who received CPAP therapy with and without regular RT involvement. Key outcomes included CPAP adherence, changes in heart failure symptoms, clinical outcomes, and patient satisfaction.Results: The RT Group demonstrated significantly higher CPAP adherence (78.4% vs. 56.7%, p < 0.001), greater improvement in NYHA functional class (mean reduction of 0.8 vs. 0.5, p = 0.002), and lower hospitalization rates (12% vs. 24%, p = 0.023) compared to the Non-RT Group. Patient satisfaction was also higher in the RT Group.Conclusion: Respiratory therapist involvement significantly enhances CPAP adherence and improves clinical outcomes in heart failure patients. Integrating RTs into the care team is essential for optimizing CPAP therapy and patient care.