Long-term Auto-Servoventilation or Constant Positive Pressure in Heart Failure and Coexisting Central With Obstructive Sleep Apnea

Randerath, Winfried; Nothofer, G; Priegnitz, Christina; Anduleit, Norbert; Treml, Marcel; Kehl, Victoria; Galetke, Wolfgang

doi:10.1378/chest.11-2089

Cited by 108 publications

(88 citation statements)

References 22 publications

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“…Second, the authors used two sets of data by Randerath et al with two different intervals of evaluation to know the efficacy of ASV on serum BNP levels in patients with HF and SDB [4]. Although I confirmed the standard mean difference of serum BNP levels after 12 months of treatment (not 6 months in their Fig.…”

mentioning

confidence: 89%

“…In addition, Zhang et al presented subgroup analysis of the efficacy of non-ASV procedure on serum BMP levels by using a study of Noda et al [3]. As the authors did not check the superiority of ASV therapy against other therapy such as non-ASV procedure, further study is needed to assess the benefit of ASV.Second, the authors used two sets of data by Randerath et al with two different intervals of evaluation to know the efficacy of ASV on serum BNP levels in patients with HF and SDB [4]. Although I confirmed the standard mean difference of serum BNP levels after 12 months of treatment (not 6 months in their Fig.…”

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confidence: 99%

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Efficacy of Positive Airway Pressure on Serum Brain Natriuretic Peptide Levels in Patients with Heart Failure and Sleep-Disordered Breathing

Kawada

2016

Lung

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To the Editor, Zhang et al. conducted a systematic review by metaanalysis with six randomized controlled trials to know the efficacy of positive airway pressure (PAP) on the levels of serum brain natriuretic peptide (BNP), which is a biomarker of heart failure (HF), in patients with HF and sleepdisordered breathing (SDB) [1]. The authors selected random effect model, and concluded that a significant reduction of BNP was observed after PAP treatment in patients with HF and SDB. I have two queries on their study.Wu et al. conducted a meta-analysis with six randomized controlled trials to know the effect of adaptive servo-ventilation (ASV) on serum BNP levels in patients with HF and SDB [2]. Although there was a decreasing trend in serum BNP level, pooled data from six studies showed no significant reduction. Three studies were having the same results with respect to subgroup of a meta-analysis by Zhang et al., and further meta-analysis is required in the future to confirm the above effect. In addition, Zhang et al. presented subgroup analysis of the efficacy of non-ASV procedure on serum BMP levels by using a study of Noda et al. [3]. As the authors did not check the superiority of ASV therapy against other therapy such as non-ASV procedure, further study is needed to assess the benefit of ASV.Second, the authors used two sets of data by Randerath et al. with two different intervals of evaluation to know the efficacy of ASV on serum BNP levels in patients with HF and SDB [4]. Although I confirmed the standard mean difference of serum BNP levels after 12 months of treatment (not 6 months in their Fig. 2), reconfirmation is needed for the standard mean difference of serum BNP levels after 3 months of treatment. In addition, please explain the difference of % weight between subgroups by Randerath et al. after 3 months and after 12 months in their Fig. 2. I suppose that the same % weight would be presented.Finally, I suspect that the efficacy of PAP on serum BNP levels in patients with HF and SDB differs by age. Mean age of subgroup data by Noda et al. [3] was 51.6 years and male % was not presented. In addition, Noda et al. handled patients with idiopathic dilated cardiomyopathy as a cause of HF. Taken together, the efficacy of non-ASV on serum brain BNP in patients with HF and SDB should be handled with caution.

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confidence: 89%

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confidence: 99%

Efficacy of Positive Airway Pressure on Serum Brain Natriuretic Peptide Levels in Patients with Heart Failure and Sleep-Disordered Breathing

Kawada

2016

Lung

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“…They investigated the potential benefit of auto-servoventilation (ASV) in addition to an optimal medical management (OMM) on cardiac function and quality of life in patients with congestive heart failure (CHF) coexisting with central and obstructive sleep apnoea (COSA). As the interest of ASV remains debated in patients with CHF and ''pure'' central sleep apnoea [2], there is no clear evidence of the superiority of ASV over constant positive airway pressure (CPAP) in patients with CHF and COSA [3][4][5]. In our opinion, some aspects of the report by ARZT et al [1] need to be underlined and discussed because of their potential daily clinical implications as well as the design of future studies.…”

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confidence: 94%

“…In other studies, such criteria on the proportion between central and obstructive events were used. For example, in a study by RANDERATH et al [3], the central events needed to represent ,80% of the total events, and the obstructive events need to represent between 20% and 50% of total events. As a consequence, without a consensus definition of ''COSA'', comparative analysis of the published studies is difficult and limited.…”

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confidence: 99%

“…Fifth, a subanalysis with the level of ASV pressure as the variable may be of interest [3][4][5]10]. Despite a study initially not powered to investigate this question, RANDERATH and TREML [5] have reported a reduction of the apnoea-hypopnoea index associated with a statistically significantly lower level of pressure treatment irrespective of the ventilator mode (ASV or CPAP).…”

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confidence: 99%

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Is auto-servoventilation unnecessary in patients with heart failure and apnoea?

Jaffuel¹,

Combes²,

Molinari

et al. 2014

Eur Respir J

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Recently, using the expensive and time-consuming ELISA method, HERESI et al. [10] have shown that plasma IL-6 concentrations .4.7 pg?mL -1 provide incremental prognostic information in PAH, with valid concentrations above the theoretical sensitivity (LLOD 0.7 pg?mL -1 ). Similarly, using MSD multiplex technology, SOON et al. [2] showed that serum IL-6 was also associated with survival in PAH patients, with concentrations (19.87¡7.45 pg?mL -1 ) above the sensitivity (LLOQ 1.58 pg?mL -1), making such a cytokine very promising for the prognosis of PAH.In conclusion, multiplex analysis provides much information from a single biological sample, and is therefore popular and more frequently used in PAH studies. However, cytokine concentrations are low and often close to the sensitivity of the assay, depending on the multiplex assays. This currently prevents the routine clinical use of such biomarkers, and should encourage clinicians to take advantage of the biochemists' analytic experience. @ERSpublications Sensitivity must be considered for cytokines when using multiplex technology in PAH-related clinical studies http://ow.ly/tAT9l

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