Death inpatients with automated servo-ventilation for sleep apnea: A case series study

Abstract

The SERVE-HF study reported an increased risk of cardiovascular death associated with adaptive servo-ventilation (ASV) for predominant central sleep apnea inpatients with chronic heart failure with reduced contractility. In May 2015, we adopted a safety procedure in the 32 patients equipped by us with ASV since 2006 that led to ASV removal in four patients due to left ventricular ejection fraction ≤ 45%. At the end of the procedure, we noted eight cases of death. This high mortality rate (25%) led us to study these cases. This is a case series study. The study population was derived from our database of patient follow-up from the sleep unit of our cardiovascular department. All deceased patients but one had cardiovascular disorders but only one matched the SERVE-HF patient profile, one who died from cancer. Four patients had been receiving ASV for predominant central sleep apnea and four for mixed sleep apnea. Six patients died prior to our procedure including two patients who died several months after ASV cessation, one from ventricular fibrillation and one from respiratory infection. The other cases, i.e. with ongoing ASV, consisted in one case of end-stage heart failure with asystole, two cases of cancer and one case of suicide. Two patients who had shown no contraindications to ASV died several weeks after their safety procedure, one from cancer and one from pulmonary and renal disorders. In this series, no obvious relationship became apparent between sleep apnea or ASV and death. Cardiovascular deaths were not predominant. Further study will be required to clarify the risks associated with ASV inpatients with cardiovascular disease.