2019
DOI: 10.5664/jcsm.8092
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Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis

Abstract: 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) com… Show more

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Cited by 22 publications
(16 citation statements)
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“…2−6 Randomized clinical trials (RCTs) evaluating oxygen and medications have been limited by their small sample sizes, thus limiting strong, evidence-based clinical recommendations. To date, systematic reviews have focused on investigating treatments for patients with CSA 7 or with HFrEF 8,9 for specific individual treatments and individual outcomes, 10,11 but not for the overall treatment effect of patients with CSA plus HFrEF. The goal of this manuscript is to provide a systematic review and meta-analysis of available RCTs examining the totality of therapies for CSA in the HFrEF population.…”
mentioning
confidence: 99%
“…2−6 Randomized clinical trials (RCTs) evaluating oxygen and medications have been limited by their small sample sizes, thus limiting strong, evidence-based clinical recommendations. To date, systematic reviews have focused on investigating treatments for patients with CSA 7 or with HFrEF 8,9 for specific individual treatments and individual outcomes, 10,11 but not for the overall treatment effect of patients with CSA plus HFrEF. The goal of this manuscript is to provide a systematic review and meta-analysis of available RCTs examining the totality of therapies for CSA in the HFrEF population.…”
mentioning
confidence: 99%
“…[30] Two meta-analyses have shown con icting results on the effects of ASV on LVEF-one showing that while ASV signi cantly reduced AHI, the effects on LVEF improvement were not signi cant [31] and the other showing signi cant improvement in LVEF with ASV as compared to control. [32] This network meta-analysis did not evaluate the comparative e cacy of treatments on LVEF improvement primarily because no such data was available from the included study on TPNS [21] and hence impossible to form a 'network' with other interventions in a network meta-analysis. Additionally, given the different follow-up durations of the various interventions in this network meta-analysis, a 6month data of LVEF changes from TPNS would conceivably not have been a fair assessment when compared to others in the network meta-analysis, primarily because a period of approximately 3 months is needed to optimally titrate nerve 'stimulation' [29] and therefore one would not expect LV remodeling to be evident until after 6 months of maximum active therapy or in other words after 9-12 months of randomization.…”
Section: Discussionmentioning
confidence: 99%
“…The treatment effect of positive pressure ventilation was larger when baseline LVEF was lower in systolic heart failure. 10 Evidently, these data support more liberal use of CPAP and ASV, with the ultimate goal of improving, on top of LVEF, other important outcomes, including functional class, rehospitalization, and fatality.…”
mentioning
confidence: 80%