Congestive heart failure (CHF) is the most common cause of hospital admission in the USA costing the taxpayers billions of dollars. Sleep-disordered breathing (SDB) is a common co-morbid condition associated with CHF with prevalence estimated to be 60-70%. Despite substantial evidence supporting the negative impact of SDB on CHF, the condition is underrecognized and undertreated. Patients admitted to the hospital with CHF and SDB are prime candidates for intervention with positive airway pressure (PAP) therapy as they form a "captive audience," and timely intervention and education may mitigate sub-optimal outcomes. In conclusion, this review explores emerging data on the cost effectiveness and outcome of early intervention with PAP in hospitalized CHF patients.