Sleep medicine · Central sleep apnoea in heart failure
Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Adaptive servo-ventilation plus guideline-based medical therapy |
| Control | Guideline-based medical therapy alone |
| Population | 1325 patients with heart failure with reduced ejection fraction and predominantly central sleep apnoea |
| Follow-up | Median 31 months |
| Primary endpoint | Composite of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalisation for worsening heart failure |
| Result | Mean AHI at 12 months was 6.6 events per hour on adaptive servo-ventilation, so the apnoea was effectively treated. The primary endpoint occurred in 54.1% versus 50.8% (hazard ratio 1.13, 95% CI 0.97 to 1.31, p=0.10). All-cause and cardiovascular mortality were both significantly higher with adaptive servo-ventilation. |
| Secondary endpoints | All-cause mortality, cardiovascular mortality, symptoms, quality of life |
Adaptive servo-ventilation had no significant effect on the primary end point in patients who had heart failure with reduced ejection fraction and predominantly central sleep apnea, but all-cause and cardiovascular mortality were both increased with this therapy.
The trial authors, in the published abstract
The clearest demonstration in respiratory medicine that correcting a physiological abnormality can kill people. The device did exactly what it was designed to do — the AHI fell to 6.6 — and patients died more often. Adaptive servo-ventilation is now contraindicated in heart failure with reduced ejection fraction.
Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N Engl J Med 2015 Sep 17;373(12):1095-105.