Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study.
BACKGROUND
Congestive heart failure (CHF) patients often present with obstructive and central sleep apnea occurring concurrently within the same night. This study assessed the efficacy of, and improvements associated with, the use of adaptive servo-ventilation (ASV) in CHF patients with all types of sleep apnea. We hypothesized that ASV would be effective at reducing sleep apnea and improving both cardiac status and quality of life.


METHODS
Eleven male patients with stable CHF and sleep apnea (apnea/hypopnea index (AHI) >15 events/h) were treated with 6 months optimized ASV and compared to 8 patients not receiving ASV. At baseline, both groups were comparable for New York Heart Association class, left ventricular ejection fraction (LVEF), plasma Brain Natriuretric Peptide (BNP) concentrations and AHI. All patients were receiving optimal medical therapy.


RESULTS
At 6 months ASV significantly reduced AHI (mean (SD), baseline 49.0 (35.1) v ASV 7.6 (14.6); p=0.001) and LVEF was increased (median (inter-quartile range), treatment group: +5.7 (1.6-9.5) v comparison group: -4.0 (-8.9-+4.6)% respectively; p=0.04) but not BNP (p=0.59). The energy/vitality score of the SF-36 quality of life questionnaire was also improved at 6 months (treatment group: +10 (5-35) v comparison group: -12 (-18-+10); p=0.005).


CONCLUSIONS
ASV effectively reduces all types of sleep apnea. Six months of use is associated with improvement in LVEF and aspects of quality of life.
Hastings
Peter C
PC
Clinical and Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK.
Vazir
Ali
A
Meadows
Guy E
GE
Dayer
Mark
M
Poole-Wilson
Philip A
PA
McIntyre
Hugh F
HF
Morrell
Mary J
MJ
Cowie
Martin R
MR
Simonds
Anita K
AK
D000368:Aged; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053158:Nocturia / Q000150:complications; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000379:methods*; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy*; D012894:Sleep Stages; D016896:Treatment Outcome; D016277:Ventricular Function, Left