title: Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial.
abstract: We tested the hypotheses that in patients with congestive heart failure (CHF) and sleep disordered breathing (SDB) auto-servoventilation (ASV) improves cardiac function and quality of life. Between March 2007 and September 2009, patients with stable CHF (left ventricular ejection fraction (LVEF) ≤ 40%) and SDB (apnoea/hypopnoea index ≥ 20 events · h(-1)) were randomised to receive either ASV (BiPAP ASV (Philips Respironics, Murrysville, PA, USA), n=37) and optimal medical management, or optimal medical management alone (n=35). Outcomes were assessed at baseline and 12 weeks. The apnoea/hypopnoea index assessed with polysomnography scored in one core laboratory was significantly more reduced in the ASV group (-39 ± 16 versus -1 ± 13 events · h(-1); p<0.001) with an average use of 4.5 ± 3.0 h · day(-1). Both groups showed similar improvements of the primary end-point LVEF (+3.4 ± 5 versus +3.5 ± 6%; p=0.915) assessed with echocardiography. In the ASV group, reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly greater (-360 ± 569 versus +135 ± 625 ng · mL(-1); p=0.010). No differences were observed between the groups in subjective quality of life. In patients with CHF and SDB, ASV reduced NT-proBNP levels, but improvement of LVEF or quality of life was not greater than in the control group. The data support that such patients can be randomised in large-scale, long-term trials of positive airway pressure therapy versus control to determine effects on cardiovascular outcome.
authors.affiliation: Division of Respirology, University Hospital Regensburg, Regensburg.
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
authors.forename: Stephan
authors.initials: S
authors.lastname: Schroll
authors.forename: Frederic
authors.initials: F
authors.lastname: Series
authors.forename: Keir
authors.initials: K
authors.lastname: Lewis
authors.forename: Amit
authors.initials: A
authors.lastname: Benjamin
authors.forename: Pierre
authors.initials: P
authors.lastname: Escourrou
authors.forename: Ruth
authors.initials: R
authors.lastname: Luigart
authors.forename: Victoria
authors.initials: V
authors.lastname: Kehl
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
mesh_terms: D000368:Aged; D000465:Algorithms; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004452:Echocardiography; D004562:Electrocardiography; D004569:Electroencephalography; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D010865:Pilot Projects; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D012913:Snoring; D013990:Tidal Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain