Abstract
<p><strong>Background:</strong> Adaptive servo-ventilation (ASV) is used to treat sleep apnea in heart failure (HF). However, it is unclear whether ASV improves the long-term prognosis for all patients with HF, regardless of the severity of sleep-disordered breathing (SDB). We therefore aimed to estimate the long-term prognosis associated with ASV therapy for patients with HF by the severity of SDB.</p><p><strong>Methods:</strong> Sixty-one consecutive patients with HF (mean age ± standard deviation: 70 ± 10 years) were initiated on ASV therapy for HF treatment after polysomnography. Patients were then classified into the following three groups based on their apnea–hypopnea index (AHI): a severe group with an AHI of ≥40/h (n = 28); a moderate group with an AHI of ≥20/h but &lt;40/h (n = 20); and a mild group with an AHI of &lt;20/h (n = 13). To estimate long-term prognosis, we reviewed the 3-year follow-up data, including that concerning fatal cardiovascular events (death from myocardial infarction, cardioembolic stroke, and fatal cardiac arrhythmias).</p><p><strong>Results:</strong> No significant differences were observed between the three study groups in the risk of fatal cardiovascular events (p = 0.207).<strong></strong></p><p><strong>Conclusions:</strong> Our results suggest that ASV therapy is associated with a good prognosis and that ASV therapy is effective, regardless of the severity of SDB.</p><p> </p>
Highlights
Sleep-disordered breathing (SDB) has a close relation to heart failure (HF), the incidence of fatal cardiovascular events, and mortality.[1]
Our results suggest that Adaptive servo-ventilation (ASV) therapy is associated with a good prognosis and that ASV therapy is effective, regardless of the severity of sleep-disordered breathing (SDB)
We reported that ASV therapy for patients with mild SDB resulted in almost equal improvements in brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) compared with patients with moderate and severe SDB, demonstrating that ASV therapy was effective for all patients with HF.[9]
Summary
Sleep-disordered breathing (SDB) has a close relation to heart failure (HF), the incidence of fatal cardiovascular events, and mortality.[1] Adaptive servo-ventilation (ASV) therapy has been shown to be effective for central sleep apnea (CSA) and Cheyne–Stokes respiration (CSR).[2,3] Recently, ASV therapy has been used to treat patients with HF who have CSA and CSR2,4,5 as well as patients with SDB, including those with obstructive sleep apnea.[6,7] Cowie et al.[8] reported that the ASV therapy for the patients with HF and reduced ejection fraction increased all-cause and cardiovascular mortality. Adaptive servo-ventilation (ASV) is used to treat sleep apnea in heart failure (HF) It is unclear whether ASV improves the long-term prognosis for all patients with HF, regardless of the severity of sleep-disordered breathing (SDB).
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