Prevention of anxiety and depression in cystic fibrosis Purpose of review Anxiety and depression (A&D) are common in cystic fibrosis (CF). This review defines A&D in the context of CF and examines our current knowledge about A&D, the impact on CF, treatment and illness trajectory and explores potential areas for prevention. Recent findings CF and A&D are interrelated. The CF diagnosis, symptoms and treatment may trigger symptoms of A&D, leading in some patients, to a clinical diagnosis of anxiety or depression. In return A&D impacts CF, potentially worsening the prognosis, decreasing treatment adherence and overall well being. Research shows how prevention is often imbedded in treatment programmes, for example cognitive behavioural therapies or motivational interviewing. Strategies that may help to prevent the onset of clinical A&D or an increase in symptoms include the implementation of psychoeducation; techniques to enhance coping and resilience; building social support networks; increasing patients’ physical exercise; and potentially, the implementation of e-health in day-to-day care. Summary To date, most A&D interventions focus on psychotherapeutic treatments, with preventive measures imbedded in programmes. The challenge lies in the improvement of our knowledge and implementation of preventive strategies to advance our care for patients with CF and to avoid clinical A&D. Correspondence to Trudy Havermans, Cystic Fibrosis Centre, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32 16 340268; e-mail: trudy.havermans@uzleuven.be Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Unilateral phrenic nerve stimulation in the therapeutical algorithm of central sleep apnoea in heart failure Purpose of review Central sleep apnoea (CSA) is highly prevalent in patients with heart failure and substantially impairs survival. If optimal cardiac treatment fails, alternative therapeutical options, including positive airway pressure (PAP) therapies, drugs or application of oxygen and carbon dioxide are considered to suppress CSA which interfere with the complex underlying pathophysiology. Most recently, unilateral phrenic nerve stimulation (PNS) has been studied in these patients. Therefore, there is an urgent need to critically evaluate efficacy, potential harm and positioning of PNS in current treatment algorithms. Recent findings Data from case series and limited randomized controlled trials demonstrate the feasibility of the invasive approach and acceptable peri-interventional adverse events. PNS reduces CSA by 50%, a figure comparable with continuous PAP or oxygen. However, PNS cannot improve any comorbid upper airways obstruction. A number of fatalities due to malignant cardiac arrhythmias or other cardiac events have been reported, although the association with the therapy is unclear. Summary PNS offers an additional option to the therapeutical portfolio. Intervention-related adverse events and noninvasive alternatives need clear discussion with the patient. The excess mortality in the SERVE-HF study has mainly been attributed to sudden cardiac death. Therefore, previous cardiac fatalities under PNS urge close observation in future studies as long-term data are missing. Correspondence to Winfried Randerath, MD, Professor of Medicine, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Bethanien Hospital, Aufderhöher Str. 169, 42699 Solingen, Germany. E-mail: randerath@klinik-bethanien.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Noninvasive volume-assured pressure support for chronic respiratory failure: a review Purpose of review Noninvasive ventilation (NIV) is an established treatment for chronic hypercapnic respiratory failure (CRF). Volume-assured pressure support (VAPS) is a mode of NIV that automatically adjusts inspiratory pressure in order to maintain a constant respiratory volume. We aim to discuss the role and application of VAPS in CRF. Recent findings Recently published meta-analyses and reviews fail to demonstrate a significant difference in gas exchange, sleep, or quality-of-life improvement in patients with CRF between VAPS and bilevel positive airway pressure (BPAP). A recent manuscript suggests that VAPS therapy in chronic obstructive pulmonary disease patients may reduce the number of exacerbations. It has been shown that with a protocol-driven approach BPAP and VAPS can both be successfully titrated during a single split-night polysomnography. Summary VAPS is as effective as other modes of NIV at improving ventilation and sleep in CRF. The potential advantage is a more consistent ventilatory support through daytime–nighttime variations and progression of disease over time. However, the impact on long-term outcomes, such as survival, has not been studied. Correspondence to Timothy I. Morgenthaler, MD, Department of Pulmonary and Critical Care Medicine and the Center for Sleep Medicine, Mayo Clinic, Rochester, MN 55905, USA. Tel: +507 266 6880; e-mail: TMorgenthaler@mayo.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.