Microstructural cerebral lesions are associated with the severity of central sleep apnea with Cheyne-Stokes-respiration in heart failure and are modified by PAP-therapy.

•Novel MRI techniques now allow to detect even subtle microstructural cerebral lesions.•Microstructural cerebral lesions might contribute to the pathophysiology of CSA-CSR in HF.•In these patients PAP-therapy of CSA-CSR induces neuronal plasticity.•Future studies are urgently needed to understand the complex pathophysiology of CSA-CSR in HF.