Sleep medicine · Central sleep apnoea in heart failure
Continuous positive airway pressure for central sleep apnea and heart failure
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | CPAP plus optimal medical therapy |
| Control | Optimal medical therapy alone |
| Population | 258 patients with heart failure and central sleep apnoea |
| Follow-up | Mean 2 years |
| Primary endpoint | Transplant-free survival |
| Result | At three months CPAP produced greater reductions in apnoea-hypopnoea frequency (-21±16 versus -2±18 per hour, p<0.001) and in noradrenaline levels, improved nocturnal oxygenation, raised the ejection fraction and increased six-minute walk distance. None of this translated into a survival difference. |
| Secondary endpoints | Ejection fraction, noradrenaline, six-minute walk distance, nocturnal oxygenation |
Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival.
The trial authors, in the published abstract
A near-perfect illustration of surrogate endpoints failing to deliver: apnoeas, catecholamines, ejection fraction and exercise capacity all improved, and patients did not live longer. The same lesson SAVE later taught for obstructive apnoea, and that SERVE-HF taught in its harshest form.
Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005 Nov 10;353(19):2025-33.