Treatment of sleep-disordered breathing with predominant central sleep apnoea by adaptive Servo-ventilation in patients with Heart Failure

Introduction: Adaptive servo-ventilation (ASV) devices are designed to suppress central respiratory events, and therefore effective for sleep-disordered breathing (SDB) in patients with heart failure (HF) and provide information about their residual respiratory events. However, whether the apnea-hypopnea index (AHI), determined by the ASV device AutoSet CS (ASC), correlates with the AHI calculated by polysomnography (PSG) in patients with HF and SDB remains to be evaluated.Methods: Consecutive patients with SDB titrated on ASC were included in the study. We assessed the correlation between AHI determined by manual scoring during PSG (AHI-PSG) and that determined by the ASC device (AHI-ASC) during an overnight session.Results: Thirty patients with HF and SDB (age, 68.8 ± 15.4 years; two women; left ventricular ejection fraction, 53.8 ± 17.9%) were included. The median AHI in the diagnostic study was 28.4 events/h, including both obstructive and central respiratory events. During the titration, ASC markedly suppressed the respiratory events (AHI-PSG, 3.3 events/h), while the median AHI-ASC was 12.8 events/h. We identified a modest correlation between AHI-PSG and AHI-ASC (r = 0.36, p = 0.048). The Brand-Altman plot indicated that the ASC device overestimated the AHI, and a moderate agreement was observed with PSG.Conclusions: There was only a modest correlation between AHI-PSG and AHI-ASC. The discrepancy may be explained by either the central respiratory events that occur during wakefulness or the other differences between PSG and ASC in the detected respiratory events. Therefore, clinicians should consider this divergence when assessing residual respiratory events using ASC.

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The Direct Effect of Adaptive Servo-ventilation on the Hemodynamic Fluctuation in Patients with Heart Failure and Sleep-disordered Breathing

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2013.08.457 ◽

2013 ◽

Vol 19 (10) ◽

pp. S167

Author(s):

Naoto Kumagai ◽

Kaoru Dohi ◽

Tadafumi Sugimoto ◽

Yuichi Sato ◽

Kiyotaka Watanabe ◽

...

Keyword(s):

Heart Failure ◽

Direct Effect ◽

Sleep Disordered Breathing ◽

Adaptive Servo Ventilation ◽

Patients With Heart Failure ◽

Disordered Breathing

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Co-morbidity (HFrEF and HFpEF): sleep-disordered breathing

ESC CardioMed ◽

10.1093/med/9780198784906.003.0420 ◽

2018 ◽

pp. 1829-1832

Author(s):

Martin R Cowie

Keyword(s):

Heart Failure ◽

Sleep Disordered Breathing ◽

Systolic Heart Failure ◽

Upper Airway ◽

Sleep Apnoea ◽

Respiratory Physiology ◽

Sympathetic Activation ◽

Central Sleep Apnoea ◽

Haemodynamic Changes ◽

Disordered Breathing

The majority of patients with heart failure have sleep-disordered breathing. There are two major types—obstructive (where the upper airway collapses, but respiratory effort continues) and central (with loss of central respiratory drive). The cyclical apnoea and hypopneas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Heart failure patients appear to be partially protected from the daytime somnolence that usually accompanies sleep-disordered breathing, perhaps by a high level of background sympathetic activation. Patients with sleep-disordered breathing have a worse prognosis than those without. Improving the control of the heart failure syndrome can improve sleep-disordered breathing. Mask-based therapies of positive airway pressure targeted at sleep-disordered breathing can improve measures of sleep quality and partially normalize the sleep and respiratory physiology, but recent randomized trials of cardiovascular outcomes in central sleep apnoea have been neutral or have even suggested the possibility of harm, likely from increased sudden death. Further randomized outcome studies are required to determine whether mask-based treatment is appropriate for patients with chronic systolic heart failure and obstructive sleep apnoea, for those with heart failure with preserved ejection fraction, and for those with decompensated heart failure. New therapies for central sleep apnoea—such as implantable phrenic nerve stimulators—also require robust assessment.

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Short-term use of adaptive servo ventilation improves renal function in heart failure patients with sleep-disordered breathing

Heart and Vessels ◽

10.1007/s00380-012-0303-0 ◽

2012 ◽

Vol 28 (6) ◽

pp. 728-734 ◽

Cited By ~ 14

Author(s):

Akiomi Yoshihisa ◽

Satoshi Suzuki ◽

Takashi Owada ◽

Shoji Iwaya ◽

Hiroyuki Yamauchi ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Sleep Disordered Breathing ◽

Short Term ◽

Adaptive Servo Ventilation ◽

Heart Failure Patients ◽

Disordered Breathing

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Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis

European Respiratory Journal ◽

10.1183/13993003.01692-2016 ◽

2017 ◽

Vol 50 (2) ◽

pp. 1601692 ◽

Cited By ~ 13

Author(s):

Holger Woehrle ◽

Martin R. Cowie ◽

Christine Eulenburg ◽

Anna Suling ◽

Christiane Angermann ◽

...

Keyword(s):

Heart Failure ◽

Sleep Apnoea ◽

Adaptive Servo Ventilation ◽

Central Sleep Apnoea ◽

Treatment Analysis

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Sleep apnoea: treatment options and sleep/cardiovascular outcome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0258 ◽

2018 ◽

pp. 1065-1069

Author(s):

Holger Woehrle ◽

Michael Arzt

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Upper Airway ◽

Sleep Apnoea ◽

Invasive Ventilation ◽

Adaptive Servo Ventilation ◽

Central Sleep Apnoea ◽

Non Invasive ◽

Non Invasive Ventilation ◽

New Treatment

In addition to lifestyle interventions, treatments for obstructive sleep apnoea focus on maintaining upper airway patency. Continuous positive airway pressure (CPAP) is recommended as first-line therapy. Beneficial cardiovascular effects of CPAP include increased intrathoracic pressure, reduced left ventricular preload and afterload, and reduced transmural cardiac pressure gradients. CPAP also reduces nocturnal ischaemia and blood pressure, and decreases the risk of post-treatment atrial fibrillation recurrence. However, secondary prevention with CPAP did not significantly reduce the rate of major cardio- and cerebrovascular events in the SAVE study. Mandibular advancement devices, surgery, and upper airway stimulation are options for patients unwilling to use or tolerate CPAP. Central sleep apnoea and Cheyne–Stokes respiration are common in patients with heart disease, especially heart failure. Adaptive servo-ventilation is the most effective therapy for alleviating central sleep apnoea with Cheyne–Stokes respiration. However, it is now contraindicated in heart failure patients with an ejection fraction of 45% or lower and predominant central sleep apnoea because of an increased risk of cardiovascular death, based on SERVE-HF study results. However, adaptive servo-ventilation may still have a role in other settings, including heart failure with preserved ejection fraction. Phrenic nerve stimulation is a new treatment modality that has shown promising results in a feasibility study. Hypoventilation is another breathing disorder that needs effective management. Data in cardiovascular disease are lacking, but CPAP and non-invasive ventilation have been shown to be effective in patients with obesity hypoventilation syndrome. Furthermore, effective reduction of chronic hypercapnia during home non-invasive ventilation treatment in patients with chronic obstructive pulmonary disease has been shown to significantly improve survival.

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