Assessing the Efficacy of Adaptive Servo-ventilation in Heart Failure Patients: A Systematic Review

Abstract Background: Central sleep apnoea (CSA) is a sleep-disordered breathing issue characterised by inadequate breathing episodes during sleep without respiratory effort. Disruptions in the central nervous system’s signalling to respiratory muscles cause inadequate ventilation and impaired gas exchange. CSA is rare in the general population but prevalent in heart failure patients. Treatment options include lifestyle changes, positive airway pressure therapy and pharmacological interventions. Adaptive servo-ventilation (ASV), a specialised form of positive airway pressure therapy, dynamically adjusts pressure based on the patient’s breathing patterns, providing tailored ventilation support for CSA patients. This innovative approach helps prevent apnoeas and hypopnoeas, ensuring the airway remains open during sleep. Methods: We conducted a comprehensive search across four electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Scopus and Web of Science) up until March 2024, to identify pertinent studies evaluating the efficacy of adaptive servo-ventilation (ASV) in the treatment of CSA in patients with heart failure. The quality of evidence from trials was assessed using ROB1. Data from the included studies were extracted into a uniform online sheet and analysed using RevMan 5.4. Results: Our search led to the identification of 9 studies involving a total of 3135 patients. The meta-analysis results demonstrated that ASV exhibited no statistically significant difference compared to controls regarding left ventricular ejection fraction (mean difference MD =2.55, 95% confidence interval CI − 0.29, 5.40 with P value of the overall effect of 0.08. Results showed significant heterogeneity ( P < 0.0001, I 2 = 83%). Moreover, it showed no difference regarding left ventricular end-diastolic and systolic volumes (MD= −1.63, 95% CI −10.09.6.82, with P = 0.70) and (MD= −0.97, 95% CI −5.47, 3.79, with P = 0.69), respectively, with no detected heterogeneity. Conclusion: In the first meta-analysis, assessing the cardiovascular outcomes of ASV in the treatment of CSA on patients with heart failure. ASV, although not significantly impacting key cardiac parameters or clinical endpoints, showed potential benefits in specific domains for certain heart failure subgroups; further research is needed to clarify its role in heart failure management and identify optimal patient populations for ASV intervention.