Adaptive servo-ventilation for central sleep apnea in heart failure
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Published version
Author(s)
Type
Journal Article
Abstract
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 guideline-based medical treatment alone (control). The primary end point in the time-to-event 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. (Funded by ResMed and others; SERVE-HF ClinicalTrials.gov number, NCT00733343. opens in new tab.)
Date Issued
2015-09-17
Online Publication Date
2016-08-18T06:00:14Z
Date Acceptance
2015-09-01
ISSN
1533-4406
Publisher
Massachusetts Medical Society
Start Page
1095
End Page
1105
Journal / Book Title
New England Journal of Medicine
Volume
373
Issue
12
Copyright Statement
Copyright © 2016 Massachusetts Medical Society. All rights reserved.
Source Database
scopus
Sponsor
ResMed Ltd
Grant Number
L02.010.062
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
POSITIVE AIRWAY PRESSURE
CHEYNE-STOKES RESPIRATION
CARDIOVASCULAR-DISEASE
BLOOD-PRESSURE
DYSFUNCTION
MORTALITY
MULTICENTER
TRIAL
Cardiovascular Diseases
Female
Heart Failure, Systolic
Humans
Male
Positive-Pressure Respiration
Sleep Apnea, Central
Aged
Cardiovascular Diseases
Female
Heart Failure, Systolic
Hospitalization
Humans
Intention to Treat Analysis
Male
Middle Aged
Positive-Pressure Respiration
Sleep Apnea, Central
Stroke Volume
Treatment Failure
Humans
Sleep Apnea, Central
Cardiovascular Diseases
Positive-Pressure Respiration
Female
Male
Heart Failure, Systolic
Humans
Sleep Apnea, Central
Cardiovascular Diseases
Stroke Volume
Treatment Failure
Hospitalization
Positive-Pressure Respiration
Aged
Middle Aged
Female
Male
Heart Failure, Systolic
Intention to Treat Analysis
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
POSITIVE AIRWAY PRESSURE
CHEYNE-STOKES RESPIRATION
CARDIOVASCULAR-DISEASE
BLOOD-PRESSURE
DYSFUNCTION
MORTALITY
MULTICENTER
TRIAL
General & Internal Medicine
11 Medical and Health Sciences
Publication Status
Published
Date Publish Online
2015-09-01