Home > Journal Club > Journal Club 30 September 2015

Journal Club 30 September 2015

Paper

Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure

Presenter

JA

Summary

BACKGROUND

Central sleep apnea is associated with poor prognosis and death in patients with
heart failure. Adaptive servo-ventilation is a therapy that uses a noninvasive ventilator
to treat central sleep apnea by delivering servo-controlled inspiratory pressure
support on top of expiratory positive airway pressure. We investigated the effects
of adaptive servo-ventilation in patients who had heart failure with reduced ejection
fraction and predominantly central sleep apnea.

METHODS

We randomly assigned 1325 patients with a left ventricular ejection fraction of 45%
or less, an apnea–hypopnea index (AHI) of 15 or more events (occurrences of apnea
or hypopnea) per hour, and a predominance of central events to receive
guideline-based medical treatment with adaptive servo-ventilation or guidelinebased
medical treatment alone (control). The primary end point in the time-toevent
analysis was the first event of death from any cause, lifesaving cardiovascular
intervention (cardiac transplantation, implantation of a ventricular assist
device, resuscitation after sudden cardiac arrest, or appropriate lifesaving shock),
or unplanned hospitalization for worsening heart failure.

RESULTS

In the adaptive servo-ventilation group, the mean AHI at 12 months was 6.6 events
per hour. The incidence of the primary end point did not differ significantly between
the adaptive servo-ventilation group and the control group (54.1% and
50.8%, respectively; hazard ratio, 1.13; 95% confidence interval [CI], 0.97 to 1.31;
P = 0.10). All-cause mortality and cardiovascular mortality were significantly
higher in the adaptive servo-ventilation group than in the control group (hazard
ratio for death from any cause, 1.28; 95% CI, 1.06 to 1.55; P = 0.01; and hazard
ratio for cardiovascular death, 1.34; 95% CI, 1.09 to 1.65; P = 0.006).

CONCLUSIONS

Adaptive servo-ventilation had no significant effect on the primary end point in
patients who had heart failure with reduced ejection fraction and predominantly
central sleep apnea, but all-cause and cardiovascular mortality were both increased
with this therapy.

Supplementary Material

A copy of the CANPAP is available here.

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