What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=32). Intervention: Adaptive servo-ventilation (ASV) vs. Continuous positive airway pressure (CPAP) and baseline. Primary outcome: Improvements in obstructive apnea, central apnea, AHI, arousal, and SpO2 min values (p=0.001).

March 29, 2023Open Access

Impact of Adaptive Servo-Ventilation in Heart Failure Patients

Key Result

One-night application of adaptive servo-ventilation eliminated Cheyne-Stokes respiration and significantly improved AHI (p=0.001), pro-BNP (p=0.036), and walking distance (p=0.018).

Study Design

Type

Observational (n=32)

Structured PICO

Does adaptive servo-ventilation improve sleep-related breathing disorders, pro-BNP, and functional capacity in patients with heart failure?

Population

32 patients with heart failure evaluated for sleep-related breathing disorders and treated with one-night ASV titration.

Intervention

One-night adaptive servo-ventilation (ASV) titration.

Comparator

Continuous positive airway pressure (CPAP) titration and baseline values.

Outcome

Polysomnography findings including obstructive apnea, central apnea, AHI, arousal, SpO2 min, and Cheyne-Stokes respiration (CSR).surrogate

In patients with heart failure and sleep-related breathing disorders, a one-night application of adaptive servo-ventilation effectively eliminated Cheyne-Stokes respiration and central apneas while improving pro-BNP and functional capacity.

Main Result

p-value: p=0.001

Abstract

Objective: Sleep-related breathing disorders (SRBD) as obstructive apnea, central apnea, and Cheyne-Stokes respiration (CSR), can be seen in patients with chronic heart failure. SRBD can influence the prognosis of heart failure. We aim to reveal sleep-related breathing disorders in heart failure patients and display the effects of adaptive servo-ventilation (ASV) as a new therapeutic modality. Materials and Methods: In this prospective study, 32 patients with heart failure were included. One night polysomnography (PSG) was done. Results: According to the results of PSG, the SRBD ratio was 96.7%. Continuous positive airway pressure (CPAP) and ASV titrations were offered to all patients with an apnea-hypopnea index (AHI) 5. Demographics, clinical properties, symptoms, PSG findings, Cheyne-Stokes respiration (CSR), and echocardiography results were recorded. Before and after ASV titration, pulmonary function tests and walking tests were performed, and concentrations of transferrin and pro-BNP were recorded. In the groups according to the AHI, severe obstructive sleep apnea syndrome (OSAS) in 18 of 30 patients, four moderate OSAS, five mild OSAS, and two central sleep apnea (CSA). PSG and, CPAP, ASV titrations were done in 7 male and one female patient that obstructive apnea, central apnea, AHI, arousal, and SpO2 min values had significant improvements (p=0,001, p=0,016, p=0,001, p=0,015 and p=0,008 respectively). We determined all CSRs were eliminated with ASV. After ASV titration pro-BNP, walking distance, and FVC values changed significantly (p=0,036, p=0,018, and p=0,018 respectively). Conclusion: As a result, we determined CSR and central apneas persisted with CPAP but were eliminated with a one-night ASV application. ASV also decreased pro-BNP and increased FVC and walking distance values significantly.