Rationale And Design Of The SERVE HF Study: Treatment Of Sleep-disordered Breathing With Predominant Central Sleep Apnea 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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Introduction to Sleep-Disordered Breathing and Treatment

Integrative Sleep Medicine ◽

10.1093/med/9780190885403.003.0031 ◽

2021 ◽

pp. 509-528

Author(s):

Joanne S. Martires ◽

Reuben Ram ◽

Jeanne Wallace

Keyword(s):

Sleep Apnea ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Sleep Apnea Syndrome ◽

Central Sleep Apnea ◽

Sleep Related Breathing Disorders ◽

Adaptive Servo Ventilation ◽

Breathing Disorders ◽

Disordered Breathing

Sleep-related breathing disorders encompass a wide range of problems that occur during sleep. The most common sleep-related breathing disorder is obstructive sleep apnea syndrome (OSAS). OSAS is increasingly prevalent, underdiagnosed and can lead to significant daytime sleepiness and disability. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS but lack of adherence to CPAP is rampant. Supportive care, education, and motivational enhancement programs do show promise in improving compliance. Alternatives to CPAP such as oral appliances, hypoglossal nerve stimulation, and myofunctional therapy have not been proved as efficacious but may provide some benefit. In the future, personalized treatment may be the best way to approach this condition. Central sleep apnea and hypoventilation are other forms of sleep-related breathing disorders. Treatment largely depends on the underlying condition but may require the use of advanced modes of noninvasive ventilation such as adaptive servo-ventilation, bilevel positive airway pressure, and volume-assured pressure support. Treatment of sleep-related breathing disorders is complex and includes seeking patient input, understanding barriers to treatment, and reevaluating patients after treatment is initiated. Successful treatment of sleep-disordered breathing can lead to improvements in daytime function, quality of life, and overall health.

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Adaptive Servo-Ventilation in Cardiac Function and Neurohormonal Status in Patients With Heart Failure and Central Sleep Apnea Nonresponsive to Continuous Positive Airway Pressure

JACC Heart Failure ◽

10.1016/j.jchf.2012.11.002 ◽

2013 ◽

Vol 1 (1) ◽

pp. 58-63 ◽

Cited By ~ 27

Author(s):

Takatoshi Kasai ◽

Satoshi Kasagi ◽

Ken-ichi Maeno ◽

Tomotaka Dohi ◽

Fusae Kawana ◽

...

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Cardiac Function ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Central Sleep Apnea ◽

Adaptive Servo Ventilation ◽

Patients With Heart Failure

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Sleep-Disordered Breathing During Congestive Heart Failure: To Intervene or Not to Intervene?

Cardiac Failure Review ◽

10.15420/cfr.2017:7:1 ◽

2017 ◽

Vol 3 (2) ◽

pp. 134 ◽

Cited By ~ 3

Author(s):

Ali Valika ◽

Maria Rosa Costanzo ◽

◽

Keyword(s):

Heart Failure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Ejection Fraction ◽

Sleep Disordered Breathing ◽

Treatment Strategies ◽

Central Sleep Apnea ◽

Reduced Ejection Fraction ◽

Obstructive Sleep ◽

Disordered Breathing

Sleep-disordered breathing is common in heart failure patients and is associated with increased morbidity and mortality. Central sleep apnea occurs more commonly in heart failure-reduced ejection fraction, and obstructive sleep apnea occurs more frequently in heart failure with preserved ejection fraction. Although the two types of sleep-disordered breathing have distinct pathophysiologic mechanisms, both contribute to abnormal cardiovascular consequences. Treatment with continuous positive airway pressure for obstructive sleep apnea in heart failure has been well defined, whereas treatment strategies for central sleep apnea in heart failure continue to evolve. Unilateral transvenous neurostimulation has shown promise for the treatment of central sleep apnea. In this paper, we examine the current state of knowledge of treatment options for sleep-disordered breathing in heart failure.

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Central Sleep Apnea

10.2310/im.1364 ◽

2020 ◽

Author(s):

Diane C Lim ◽

Richard J Schwab

Keyword(s):

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Central Sleep Apnea ◽

Respiratory Muscles ◽

Supplemental Oxygen ◽

Opioid Therapy ◽

Phox2b Gene ◽

Adaptive Servo Ventilation ◽

Ventilatory Drive ◽

Disordered Breathing

As part 3 of the three chapters on sleep-disordered breathing, this chapter reviews central sleep apnea (CSA). CSA is defined as recurrent apneic events during sleep in the absence of respiratory muscle effort and loss of neuronal output to respiratory muscles. The most common cause of CSA is compromised cardiac function. In patients with CSA whose ejection fraction is less than or equal to 45%, adaptive servo-ventilation (ASV) has been shown to increase mortality. With the abuse of opioids reaching epidemic proportions, it has been estimated that 30 to 75% of patients on chronic opioid therapy have a significant increased incidence of CSA. Opioid-induced sleep-disordered breathing can be treated with ASV. This review contains 1 figure, and 37 references. Key Words: adaptive servo-ventilation, central sleep apnea, Cheyne-Stokes respiration, congenital central hypoventilation syndrome, impaired central ventilatory drive, opioid abuse, PHOX2B gene, supplemental oxygen

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Current and Future Use of Adaptive Servo-Ventilation

European Respiratory & Pulmonary Diseases ◽

10.17925/erpd.2016.02.01.1 ◽

2016 ◽

Vol 02 (01) ◽

pp. 1

Author(s):

Marie-Pia d’Ortho ◽

◽

Holger Woehrle ◽

Michael Arzt ◽

...

Keyword(s):

Heart Failure ◽

Sleep Disordered Breathing ◽

Systolic Heart Failure ◽

Central Sleep Apnea ◽

Opioid Therapy ◽

Small Subset ◽

Specific Patient ◽

Adaptive Servo Ventilation ◽

Increased Risk ◽

Disordered Breathing

Adaptive servo-ventilation (ASV) is a form of non-invasive positive airway pressure (PAP) therapy that differs from other PAP devices. It includes features to overcome both obstructive and central sleep-disordered breathing (SDB) events. In the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo-Ventilation in Patients with Heart Failure (SERVE-HF) study, ASV significantly reduced SDB events in patients with systolic heart failure (HF) and predominant central sleep apnoea (CSA), but did not improve outcomes, and there was increased mortality risk in the ASV group. Although the SERVE-HF results represent a paradigm shift for ASV, they are only applicable to a small subset of ASV-treated patients, and there is no evidence suggesting that ASV use should stop altogether. There are a number of other indications and patient groups for whom ASV may be useful, effective and safe, including patients with treatment-emergent CSA, central apnoeas associated with long-term opioid therapy without alveolar hypoventilation, idiopathic Cheyne-Stokes respiration, after ischaemic stroke and those with HF with preserved ejection fraction. Additional research is required to better define the mechanism of increased risk associated with ASV identified in SERVE-HF and to more clearly characterise the specific patient phenotypes who benefit from ASV therapy.

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