Adaptive Servo-Ventilation in Cardiac Function and Neurohormonal Status in Patients With Heart Failure and Central Sleep Apnea Nonresponsive to Continuous Positive Airway Pressure

Kasai, Takatoshi; Kasagi, Satoshi; Maeno, Ken-ichi; Dohi, Tomotaka; Kawana, Fusae; Kato, Megumi; Naito, Ryo; Ishiwata, Sugao; Ohno, Minoru; Yamaguchi, Tetsu; Narui, Koji; Momomura, Shin‐ichi

doi:10.1016/j.jchf.2012.11.002

Cited by 56 publications

(45 citation statements)

References 18 publications

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“…Randomized and observational studies in which the effects of ASV on cardiac function were assessed showed that suppression of CSA via ASV reduced the levels of neurohumoral factors and improved LV systolic function and outcomes in chronic HF patients with CSA [106][107][108][109] . Furthermore, in studies on the effects of ASV on suppression of AHI and improvements of cardiac function in CPAP non-responders, CSA was sufficiently decreased in response to ASV, and cardiac functions and neurohumoral state were improved at 3 mo [110] . The effects of ASV on long-term clinical outcomes in chronic HF patients with CSA will be clarified in an ongoing large-scale randomized controlled trial [111,112] .…”

Section: Acute Decompensated Hfmentioning

confidence: 98%

Positive airway pressure therapy for heart failure

Kato

Suda

Kasai

2014

WJC

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Section: Acute Decompensated Hfmentioning

confidence: 98%

Positive airway pressure therapy for heart failure

Kato

Suda

Kasai

2014

WJC

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“…69 In a second cohort of Japanese men with HFrEF whose CSA was refractory to CPAP, 3 months' treatment with peak-flow ASV delivered by nasal mask effectively suppressed central apneas, reduced urinary NE excretion and increased LVEF. 70 Thus, the innovation of ASV resolved the issue of efficacy and invigorated enthusiaccepted CPAP treatment (P=0.07 vs. untreated OSA). 45 Kasai et al documented a similar benefit but noted that a reduction in risk of death or hospitalization required good adherence to CPAP therapy.…”

Section: Randomized Trials With Mortality and Morbidity Endpointsmentioning

confidence: 99%

Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―

Haruki

Floras

2017

Circ J

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for their deployment can be advocated (Table). However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure (PAP) was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, 7 and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. 3 Consequently, equipoise remains as to whether either OSA or CSA, once detected in a HF patient with reduced left ventricular ejection fraction (LVEF), should be therapeutically suppressed. The threefold purpose of this review was to: (1) summarize current knowledge concerning the prevalence, pathophysiology, and prognostic implications of SDB in HF in support of treatment; (2) examine and reflect upon the results of randomized controlled trials evaluating the effect of treating OSA or CSA on cardiovascular endpoints and mortality; and (3) illustrate how ADVENT-HF, a randomized controlled trial designed to determine the effect of treating HF patients with either CSA or nonsleepy OSA using a peak-airflow triggered ASV algorithm, could resolve the present clinical equipoise concerning the treatment of one or both forms of SDB.A fundamental and as yet unresolved question for the heart failure (HF) community is whether coexisting obstructive (OSA) or central sleep apnea (CSA) should be specific targets of therapy. For individuals without HF, the principal clinical indication to treat sleep apnea is to improve quality of life (QOL) and avert accidental injury or death by alleviating daytime hypersomnolence. However, this indication does not pertain to the majority of patients with reduced left ventricular systolic function and sleep-disordered breathing (SDB) as they are not burdened by excess daytime sleepiness. 1-3 In such individuals, the impetus to diagnosis and treatment is the hypothesis that attenuation or abolition of SDB will modify beneficially the natural history of HF.OSA and CSA interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. 4-6 Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute consequences of such stimuli or on the long-term structural and functional adaptations they induce within the atria and ventricles, the brain and the peripheral vasculature, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. Importantly, effective treatment is presently available for both OSA and CSA and cogent reasons Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt brea...

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“…9,10) Recently, several authors reported the efficacy of ASV in improving clinical outcomes during a short-(~days) or midterm (~months) study period in patients with mild to moderate HF (New York Heart Association [NYHA] class II-III) complicated by SDB. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, the long-term efficacy of ASV therapy in patients with advanced HF is uncertain. Moreover, most of the previous studies demonstrated improvement only in surrogate markers but not hard endpoints.…”

mentioning

confidence: 99%

Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome

et al. 2016

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SummaryAdaptive servo-ventilation (ASV) is a recently developed, noninvasive therapeutic tool for the treatment of heart failure (HF). However, the efficacy of ASV therapy in patients with advanced HF remains uncertain, especially as regards its contribution to freedom from cardiac replacement therapy. A total of 85 patients with advanced HF (New York Heart Association [NYHA] class IV 71%, inotrope infusion-dependent 34%) refractory to guideline-directed medical therapy, received ASV therapy, irrespective of sleep-disordered breathing, at our institute between 2008 and 2014. Among these 85 patients, 46 continued ASV therapy for > 1 month (continued group), whereas 39 discontinued the therapy after < 1 month because of intolerance (discontinued group). There were no significant differences in baseline variables between the two groups. Heart rate indicating sympathetic activity, left ventricular (LV) reverse remodeling assessed by LV diastolic diameter, LV ejection fraction, and the grades of mitral and tricuspid regurgitations, HF severity assessed by NYHA class and plasma level of B-type natriuretic peptide, and end-organ dysfunction, improved significantly at 6 months following the initiation of ASV therapy (P < 0.05 for all). All-cause mortality and cardiac death rate were significantly lower during 2-year follow up in the continued group (P < 0.05 for both). In conclusion, ASV is a novel therapeutic tool prior to cardiac replacement therapy in patients with advanced HF and may prolong the period until cardiac replacement therapy becomes necessary. (Int Heart J 2016; 57: 47-52)

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Adaptive Servo-Ventilation in Cardiac Function and Neurohormonal Status in Patients With Heart Failure and Central Sleep Apnea Nonresponsive to Continuous Positive Airway Pressure

Abstract: Patients with HF and unsuppressed CSA despite receiving CPAP may receive additional benefit by having CPAP replaced with ASV. Additionally, effective suppression of CSA may improve cardiac function in HF patients.

Cited by 56 publications

References 18 publications

Positive airway pressure therapy for heart failure

Positive airway pressure therapy for heart failure

Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―

Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome

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Adaptive Servo-Ventilation in Cardiac Function and Neurohormonal Status in Patients With Heart Failure and Central Sleep Apnea Nonresponsive to Continuous Positive Airway Pressure

Abstract: Patients with HF and unsuppressed CSA despite receiving CPAP may receive additional benefit by having CPAP replaced with ASV. Additionally, effective suppression of CSA may improve cardiac function in HF patients.

Cited by 56 publications

References 18 publications

Positive airway pressure therapy for heart failure

Positive airway pressure therapy for heart failure

Sleep-Disordered Breathing in Heart Failure ― A Therapeutic Dilemma ―

Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome

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Product

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Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―