title: Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial.
abstract: Both types of sleep-disordered breathing (SDB), obstructive and central sleep apnoea (OSA and CSA, respectively), are common in patients with heart failure and reduced ejection fraction (HFrEF). In such patients, SDB is associated with increased cardiovascular morbidity and mortality but it remains uncertain whether treating SDB by adaptive servo-ventilation (ASV) in such patients reduces morbidity and mortality.
  
  
  
  ADVENT-HF is designed to assess the effects of treating SDB with ASV on morbidity and mortality in patients with HFrEF.
  
  
  
  ADVENT-HF is a multicentre, multinational, randomized, parallel-group, open-label trial with blinded assessment of endpoints of standard medical therapy for HFrEF alone vs. with the addition of ASV in patients with HFrEF and SDB. Patients with a history of HFrEF undergo echocardiography and polysomnography. Those with a left ventricular ejection fraction ≤45% and SDB (apnoea-hypopnoea index ≥15) are eligible. SDB is stratified into OSA with ≥50% of events obstructive or CSA with >50% of events central. Those with OSA must not have excessive daytime sleepiness (Epworth score of ≤10). Patients are then randomized to receive or not receive ASV. The primary outcome is the composite of all-cause mortality, cardiovascular hospital admissions, new-onset atrial fibrillation requiring anti-coagulation but not hospitalization, and delivery of an appropriate discharge from an implantable cardioverter-defibrillator not resulting in hospitalization during a maximum follow-up time of 5 years.
  
  
  
  The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.
authors.affiliation: Women's College Hospital, Toronto, ON, Canada.
authors.forename: Owen D
authors.initials: OD
authors.lastname: Lyons
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: John S
authors.initials: JS
authors.lastname: Floras
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Beanlands
authors.affiliation: Hospital Universitario Txagorritxu, Vitoria, Spain.
authors.forename: Joaquin Durán
authors.initials: JD
authors.lastname: Cantolla
authors.affiliation: Queen's University, Kingston, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Fitzpatrick
authors.affiliation: Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Fleetham
authors.affiliation: McGill University Health Centre, Montreal, QC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: John Kimoff
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Richard S T
authors.initials: RS
authors.lastname: Leung
authors.affiliation: Instituto do Coração do Hospital das Clínicas da FMUSP, Sao Paulo, Brazil.
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi Filho
authors.affiliation: Hôpital Hôtel-Dieu du CHUM, Université de Montréal, Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mayer
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mielniczuk
authors.affiliation: Capital District Health Authority, Halifax, NS, Canada.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Morrison
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Clodagh M
authors.initials: CM
authors.lastname: Ryan
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
authors.forename: Frederic
authors.initials: F
authors.lastname: Series
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Tomlinson
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Woo
authors.affiliation: Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
authors.affiliation: University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Sairam
authors.initials: S
authors.lastname: Parthasarathy
authors.affiliation: Groupe Hospitalier Pitie-Salpetriere Charles Fox, Paris, France.
authors.forename: Stefania
authors.initials: S
authors.lastname: Redolfi
authors.affiliation: Juntendo University Hospital, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Ospedale San Luca, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Diego H
authors.initials: DH
authors.lastname: Delgado
authors.affiliation: University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: T Douglas
authors.initials: TD
authors.lastname: Bradley
mesh_terms: D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D017286:Polysomnography; D012121:Respiration, Artificial / Q000379:methods*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000628:therapy*; D020182:Sleep Apnea, Central / Q000150:complications / Q000628:therapy; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Adaptive servo-ventilation; Cardiovascular hospital admissions; Central sleep apnoea; Heart failure; Mortality; Obstructive sleep apnoea; Sleep-disordered breathing