A retrospective analysis of cardiovascular outcomes in patients treated with ASV

Hetland, Arild; Haugaa, Kristina H.; Vistnes, Maria; Liland, Kristian Hovde; Olseng, Margareth; Jacobsen, Morten; Edvardsen, Thor

doi:10.1080/14017431.2016.1262546

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…Nonrandomized controlled trials did not confirm the findings of an adverse effect of ASV on cardiovascular mortality. 26,27 Although meta-regression has shown that treating CSA/CSR with PPV seems to be more effective in improving LVEF when systolic function is more impaired, the mortality risk was markedly increased in the subgroup of patients with HFrEF in the SERVE-HF trial allocated to ASV with an LVEF < 30%. 28 Taken together, this supports that the adverse outcome observed in the ASV arm of the SERFE-HF trial is likely due to arrhythmia and not the effects on cardiac function.…”

Section: Results In the Context Of The Literaturementioning

confidence: 99%

Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis

Schwarz

Scherff²,

Haile

et al. 2019

Journal of Clinical Sleep Medicine

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Study Objectives: Patients who have experienced heart failure with central sleep apnea/Cheyne-Stokes respiration (CSA/CSR) have an impaired prognosis. Continuous positive airway pressure (CPAP) and adaptive servoventilation (ASV) as well as nocturnal oxygen (O 2 ) are proposed treatment modalities of CSA/CSR. The goal of the study is to assess whether and how different treatments of CSA/CSR affect cardiac function. Methods: Databases were searched up to December 2017 for randomized controlled trials (RCTs) comparing the effect of any combination of CPAP, ASV, O 2 or an inactive control on left ventricular ejection fraction (LVEF) in patients with heart failure and CSA/CSR. A systematic review and network meta-analysis using multivariate random-effects meta-regression were performed. Results: Twenty-four RCTs (1,289 patients) were included in the systematic review and data of 16 RCTs (951 patients; apnea-hypopnea-index 38 ± 3/h, LVEF 29 ± 3%) could be pooled in a network meta-analysis. Compared to an inactive control, both CPAP and ASV significantly improved LVEF by 4.4% (95% confidence interval 0.3-8.5%, P = 0.036) and 3.8% (95% confidence interval 0.6-7.0%, P = 0.025), respectively, whereas O 2 had no effect on LVEF (P = 0.35). There was no difference in treatment effects on LVEF between CPAP and ASV (P = 0.76). The treatment effect of positive pressure ventilation was larger when baseline LVEF was lower in systolic heart failure. Conclusions: CPAP and ASV are effective in improving LVEF in patients with heart failure and CSA/CSR to a clinically relevant amount, whereas nocturnal O 2 is not. There is no difference between CPAP and ASV in the comparative beneficial effect on cardiac function.

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Section: Results In the Context Of The Literaturementioning

confidence: 99%

Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis

Schwarz

Scherff²,

Haile

et al. 2019

Journal of Clinical Sleep Medicine

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“…In central sleep apnea syndrome specific is the cessation of breathing during sleep due to the total abolishment of respiratory muscle activity, by the absence of nerve impulse . This syndrome can be divided (2,3) into several categories, each with a unique physiopathology and a specific treatment.…”

mentioning

confidence: 99%

“…(9) Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates . At this time, it is uncertain (1,3) whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology.…”

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confidence: 99%

The Profile of Romanian Patient with Central Sleep Apnea and Heart Failure

2021

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Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology. Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults > 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups. The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.

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Non-invasive positive pressure ventilation for central sleep apnoea in adults

Pinto

Rocha

Pachito

et al. 2022

Cochrane Database of Systematic Reviews

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A retrospective analysis of cardiovascular outcomes in patients treated with ASV

Abstract: In CHF patients with CSR, 18 months ASV treatment did not significantly affect cardiovascular death or combined cardiovascular death or hospital admissions. But there was a trend toward better combined outcome.

Cited by 6 publications

References 27 publications

Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis

Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis

The Profile of Romanian Patient with Central Sleep Apnea and Heart Failure

Non-invasive positive pressure ventilation for central sleep apnoea in adults

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