Key result
Only ~10% of real-world ASV-treated patients meet SERVE-HF high-risk criteria.
Cohort (n=293)
No
The generalized restriction of adaptive servoventilation following the SERVE-HF trial may be unwarranted in real-world practice, as the vast majority of treated patients do not share the trial's high-risk profile.
Most real-world ASV recipients differ from SERVE-HF high-risk profile; leaves open whether broad restrictions apply beyond that narrow subgroup.
Adaptive servoventilation (ASV) has proven effective at suppressing breathing disturbances during sleep, improving quality of life and cardiac surrogate parameters. Since the publication of the SERVE-HF-trial, ASV became restricted. The purpose of this study was to evaluate the clinical relevance of the SERVE-HF inclusion criteria in real life and estimate the portion of patients with these criteria with or without risk factors who are undergoing ASV treatment. We performed a retrospective study of all patients who were treated with ASV in a university-affiliated sleep laboratory. We reviewed the history of cardiovascular diseases, echocardiographic measurements of left ventricular ejection fraction (LVEF) and polysomnography. From 1998 to 2015, 293 patients received ASV, of which 255 (87.0%) had cardiovascular diseases and 118 (40.3%) had HF. Among those with HF, the LVEF was ≤45% in 47 patients (16.0%). Only 12 patients (4.1%) had LVEF <30%. The SERVE-HF inclusion criteria were present in 28 (9.6%) ASV recipients. Of these patients, 3 died within 30-58 months of therapy, all with systolic HF and a LVEF <30%. In this study, only a small minority of ASV patients fell in the risk group. The number of fatalities did not exceed the expected mortality in optimally treated systolic HF patients.
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Randerath et al. (2017) conducted a cohort in Sleep disordered breathing treated with adaptive servoventilation (n=293). Adaptive servoventilation was evaluated on Proportion of patients fulfilling SERVE-HF inclusion criteria (HFrEF ≤45% and predominant central sleep apnea). In a real-world cohort of patients treated with adaptive servoventilation, only 9.6% fulfilled the SERVE-HF trial high-risk inclusion criteria of systolic heart failure and predominant central sleep apnea.
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