title: Adaptive servoventilation improves cardiorenal function and prognosis in heart failure patients with chronic kidney disease and sleep-disordered breathing.
abstract: BACKGROUND
  Chronic kidney disease (CKD) and sleep-disordered breathing (SDB) play critical roles in the progression of chronic heart failure (CHF). However, it still remains unclear whether adaptive servoventilation (ASV) improves cardiorenal function and the prognosis of CHF patients with CKD and SDB.
  
  
  RESULTS
  Eighty CHF patients with CKD (estimated glomerular filtration rate of <60 mL min(-1) 1.73 cm(-2)) and SDB (apnea-hypopnea index >15/h) were enrolled and divided into 2 groups: 36 patients were treated with usual care plus ASV (ASV group) and 44 patients were treated with usual care alone (Non-ASV group). Levels of B-type natriuretic peptide, glomerular filtration rate, cystatin C, C-reactive protein, noradrenaline, and left ventricular ejection fraction were measured before treatment and 6 months after treatment. Patients were followed to register cardiac events occurring after enrollment. Six months of ASV therapy reduced levels of B-type natriuretic peptide, cystatin C, C-reactive protein, and noradrenaline and improved the glomerular filtration rate and ejection fraction (all P < .05). However, none of these parameters changed in the Non-ASV group. Thirty-two events (14 deaths and 18 rehospitalizations) occurred during the follow-up period (mean 513 days). Importantly, the event-free rate was significantly higher in the ASV group than in the Non-ASV group (77.8% vs 45.5%; log rank P < .01).
  
  
  CONCLUSIONS
  ASV improves the prognosis of CHF patients with CKD and SDB, with favorable effects such as the improvement of cardiorenal function and attenuation of inflammation and sympathetic nervous activity.
authors.affiliation: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Owada
authors.forename: Akiomi
authors.initials: A
authors.lastname: Yoshihisa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Iwaya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Yamaki
authors.forename: Kochi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kunii
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakazato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shu-Ichi
authors.initials: S
authors.lastname: Saitoh
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome