Continuous Positive Airway Pressure and Adaptive Servoventilation in Heart Failure Patients With Central Sleep Apnea With Cheyne Stokes Respiration: Are They Useful in Ameliorating Cardiac Systolic Dysfunction?

Roever, Leonardo; Tse, Gary; Biondi‐Zoccai, Giuseppe

doi:10.5664/jcsm.8106

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“…A recent meta-analysis showed that CPAP and ASV are effective in improving LVEF in patients with heart failure as well as CSA/CSR in a clinically relevant manner, whereas nocturnal O2 is not. There were no differences between CPAP and ASV in terms of beneficial effects on cardiac function [19,20]. The SERVE-HF [21] study sought to investigate the long-term effects of ASV in selected patients with reduced EF and dominant central apnoea.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Cheyne–Stokes respiration with adaptive servoventilation—analysis of patients with regard to therapy restriction

2020

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Purpose The SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI] > 15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI] > 50% and central apnoea index [CAI] > 10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical relevance of this limitation. Methods Data were analysed retrospectively for patients treated with ASV who received follow-up echocardiography to identify contraindications for ASV. Results Echocardiography was conducted in 23 patients. The echocardiogram was normal in 10 cases, a left ventricular hypertrophy with normal EF was found in 8 patients, there was an EF 45–50% in 2 cases and a valvular aortic stenosis (grade II) with normal EF was found in 1 case. EF <45% was present in just 2 cases, and only 1 of these patients also had more than 50% central events in the diagnostic night. Conclusion The population typically treated with ASV is entirely different from the study population in SERVE-HF, as nearly half of the patients treated with ASV showed a normal echocardiogram. Thus, the modified indication for ASV has little impact on the majority of treated patients. The current pathomechanistic hypothesis of central apnoea must be reviewed.

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Section: Introductionmentioning

confidence: 99%

Treatment of Cheyne–Stokes respiration with adaptive servoventilation—analysis of patients with regard to therapy restriction

2020

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Continuous Positive Airway Pressure and Adaptive Servoventilation in Heart Failure Patients With Central Sleep Apnea With Cheyne Stokes Respiration: Are They Useful in Ameliorating Cardiac Systolic Dysfunction?

Abstract: Commentary on Schwarz et al. Effect of treatment of central sleep apnea/Cheyne-Stokes respiration on left ventricular ejection fraction in heart failure: a network meta-analysis.

Cited by 1 publication

References 10 publications

Treatment of Cheyne–Stokes respiration with adaptive servoventilation—analysis of patients with regard to therapy restriction

Treatment of Cheyne–Stokes respiration with adaptive servoventilation—analysis of patients with regard to therapy restriction

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