Adaptive servo-ventilation and mortality in patients with systolic heart failure and central sleep apnea: a single-center experience.
ASV
Adaptive servo-ventilation
CSA
Central sleep apnea
Journal
Sleep & breathing = Schlaf & Atmung
ISSN: 1522-1709
Titre abrégé: Sleep Breath
Pays: Germany
ID NLM: 9804161
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
06
12
2022
accepted:
06
03
2023
revised:
24
01
2023
medline:
4
10
2023
pubmed:
16
3
2023
entrez:
15
3
2023
Statut:
ppublish
Résumé
Central sleep apnea (CSA) is associated with increased mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). Treatment of CSA with a certain type of adaptive servo-ventilation (ASV) device that targets minute ventilation (ASVmv) was found to be harmful in these patients. A newer generation of ASV devices that target peak flow (ASVpf) is presumed to have different effects on ventilation and airway patency. We analyzed our registry of patients with HFrEF-CSA to examine the effect of exposure to ASV and role of each type of ASV device on mortality. This is a retrospective cohort study in patients with HFrEF and CSA who were treated with ASV devices between 2008 and 2015 at a single institution. Mortality data were collected through the institutional data honest broker. Usage data were obtained from vendors' and manufacturers' servers. Median follow-up was 64 months. The registry included 90 patients with HFrEF-CSA who were prescribed ASV devices. Applying a 3-h-per-night usage cutoff, we found a survival advantage at 64 months for those who used the ASV device above the cutoff (n = 59; survival 76%) compared to those who did not (n = 31; survival 49%; hazard ratio 0.44; CI 95%, 0.20 to 0.97; P = 0.04). The majority (n = 77) of patients received ASVpf devices with automatically adjusting end-expiratory pressure (EPAP) and the remainder (n = 13) received ASVmv devices mostly with fixed EPAP (n = 12). There was a trend towards a negative correlation between ASVmv with fixed EPAP and survival. In this population of patients with HFrEF and CSA, there was no evidence that usage of ASV devices was associated with increased mortality. However, there was evidence of differential effects of type of ASV technology on mortality.
Sections du résumé
BACKGROUND
Central sleep apnea (CSA) is associated with increased mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). Treatment of CSA with a certain type of adaptive servo-ventilation (ASV) device that targets minute ventilation (ASVmv) was found to be harmful in these patients. A newer generation of ASV devices that target peak flow (ASVpf) is presumed to have different effects on ventilation and airway patency. We analyzed our registry of patients with HFrEF-CSA to examine the effect of exposure to ASV and role of each type of ASV device on mortality.
METHODS
This is a retrospective cohort study in patients with HFrEF and CSA who were treated with ASV devices between 2008 and 2015 at a single institution. Mortality data were collected through the institutional data honest broker. Usage data were obtained from vendors' and manufacturers' servers. Median follow-up was 64 months.
RESULTS
The registry included 90 patients with HFrEF-CSA who were prescribed ASV devices. Applying a 3-h-per-night usage cutoff, we found a survival advantage at 64 months for those who used the ASV device above the cutoff (n = 59; survival 76%) compared to those who did not (n = 31; survival 49%; hazard ratio 0.44; CI 95%, 0.20 to 0.97; P = 0.04). The majority (n = 77) of patients received ASVpf devices with automatically adjusting end-expiratory pressure (EPAP) and the remainder (n = 13) received ASVmv devices mostly with fixed EPAP (n = 12). There was a trend towards a negative correlation between ASVmv with fixed EPAP and survival.
CONCLUSION
In this population of patients with HFrEF and CSA, there was no evidence that usage of ASV devices was associated with increased mortality. However, there was evidence of differential effects of type of ASV technology on mortality.
Identifiants
pubmed: 36920657
doi: 10.1007/s11325-023-02807-2
pii: 10.1007/s11325-023-02807-2
pmc: PMC10539434
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1909-1915Informations de copyright
© 2023. The Author(s).
Références
Am J Respir Crit Care Med. 2001 Aug 15;164(4):614-9
pubmed: 11520725
N Engl J Med. 2005 Nov 10;353(19):2025-33
pubmed: 16282177
Sleep Med. 2015 Dec;16(12):1495-6
pubmed: 26611946
Circulation. 2000 Jul 4;102(1):61-6
pubmed: 10880416
J Clin Sleep Med. 2012 Oct 15;8(5):597-619
pubmed: 23066376
Eur J Heart Fail. 2008 Jun;10(6):581-6
pubmed: 18486550
J Appl Physiol (1985). 1996 May;80(5):1528-39
pubmed: 8727536
Circ J. 2011;75(3):710-2
pubmed: 21266785
Circ J. 2006 Sep;70(9):1148-54
pubmed: 16936427
Am J Respir Crit Care Med. 1999 Oct;160(4):1101-6
pubmed: 10508793
Circ Heart Fail. 2010 Jan;3(1):140-8
pubmed: 19933407
J Card Fail. 2009 Nov;15(9):739-46
pubmed: 19879459
Chest. 2020 Jun;157(6):1637-1646
pubmed: 31958442
Am Heart J. 2008 Oct;156(4):662-73
pubmed: 18926148
Circ J. 2011;75(5):1164-9
pubmed: 21378449
Am J Respir Crit Care Med. 1994 Dec;150(6 Pt 1):1598-604
pubmed: 7952621
Chest. 2016 Apr;149(4):900-4
pubmed: 26836904
Sleep. 2011 Dec 01;34(12):1693-8
pubmed: 22131607
J Clin Sleep Med. 2016 May 15;12(5):757-61
pubmed: 27092695
Int Heart J. 2011;52(4):218-23
pubmed: 21828947
J Appl Physiol (1985). 1995 May;78(5):1806-15
pubmed: 7649916
N Engl J Med. 2015 Sep 17;373(12):1095-105
pubmed: 26323938
Sleep Med. 2009 Sep;10(8):898-903
pubmed: 19303811
Am J Respir Crit Care Med. 1995 Aug;152(2):473-9
pubmed: 7633695
Chest. 2014 Aug;146(2):514-523
pubmed: 25091757
Am J Respir Crit Care Med. 2019 Apr 1;199(7):925-928
pubmed: 30605350
Eur Respir J. 2019 Feb 21;53(2):
pubmed: 30409822
Sleep. 2013 Aug 01;36(8):1163-71
pubmed: 23904676
J Sleep Res. 2006 Sep;15(3):321-8
pubmed: 16911035
Eur Heart J. 2015 Jun 14;36(23):1463-9
pubmed: 25636743
Am J Respir Crit Care Med. 1995 Jan;151(1):92-7
pubmed: 7812579
Arch Intern Med. 2008 Apr 28;168(8):847-54
pubmed: 18443260
J Card Fail. 2012 Jul;18(7):534-40
pubmed: 22748486
Eur J Heart Fail. 2007 Mar;9(3):251-7
pubmed: 17027333
Sleep Med. 2008 Aug;9(6):652-9
pubmed: 18024166
Chest. 2012 Aug;142(2):440-447
pubmed: 22281801