scholarly journals Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF

2017 ◽  
Vol 20 (3) ◽  
pp. 536-544 ◽  
Author(s):  
Martin R. Cowie ◽  
Holger Woehrle ◽  
Karl Wegscheider ◽  
Eik Vettorazzi ◽  
Susanne Lezius ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Sleep Apnoea ◽  
Adaptive Servo Ventilation ◽  
Central Sleep Apnoea

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

2017 ◽  
Vol 50 (2) ◽  
pp. 1601692 ◽  
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

Sleep apnoea: treatment options and sleep/cardiovascular outcome

ESC CardioMed ◽  
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.

Sleep duration and architecture during ASV for central sleep apnoea in systolic heart failure

2020 ◽  
Vol 271 ◽  
pp. 103286 ◽  
Author(s):  
Fabian Roder ◽  
Birgit Wellmann ◽  
Thomas Bitter ◽  
Henrik Fox ◽  
Anke Türoff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Duration ◽  
Systolic Heart Failure ◽  
Sleep Apnoea ◽  
Central Sleep Apnoea

scholarly journals Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217205
Author(s):  
Renaud Tamisier ◽  
Thibaud Damy ◽  
Sebastien Bailly ◽  
Jean-Marc Davy ◽  
Johan Verbraecken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Latent Class ◽  
Systolic Heart Failure ◽  
Sleep Apnoea ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
The Face

RationaleAdaptive servo ventilation (ASV) is contraindicated in patients with systolic heart failure (HF) who have a left ventricular ejection fraction (LVEF) below 45% and predominant central sleep apnoea (CSA). However, the effects of ASV in other HF subgroups have not been clearly defined.ObjectiveThe European, multicentre, prospective, observational cohort trial, FACE, evaluated the effects of ASV therapy on morbidity and mortality in patients with HF with sleep-disordered breathing (SDB); 3-month outcomes in patient subgroups defined using latent class analysis (LCA) are presented.MethodsConsecutive patients with HF with predominant CSA (±obstructive sleep apnoea) indicated for ASV were included from 2009 to 2018; the non-ASV group included patients who refused/were noncompliant with ASV. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention or unplanned hospitalisation for worsening of chronic HF).Measurements and main resultsBaseline assessments were performed in 503 patients, and 482 underwent 3-month follow-up. LCA identified six discrete patient clusters characterised by variations in LVEF, SDB type, age, comorbidities and ASV acceptance. The 3- month rate of primary outcome events was significantly higher in cluster 1 patients (predominantly men, low LVEF, severe HF, CSA; 13.9% vs 1.5%–5% in other clusters, p<0.01).ConclusionFor the first time, our data identified homogeneous patient clusters representing clinically relevant subgroups relating to SDB management in patients with HF with different ASV usage, each with a different prognosis. This may improve patient phenotyping in clinical practice and allow individualisation of therapy.

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

ESC CardioMed ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document