Design of the effect of adaptive servo‐ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT‐HF trial

Lyons, Owen D.; Floras, John S.; Logan, Alexander G.; Beanlands, Robert; Cantolla, Joaquín Durán; Fitzpatrick, Michael; Fleetham, John A.; Kimoff, R. John; Leung, Richard; Lorenzi-Filho, Geraldo; Mayer, Pierre; Mielniczuk, Lisa; Morrison, Debra; Ryan, Clodagh M.; Sériès, Frédéric; Tomlinson, George; Woo, Anna; Arzt, Michael; Parthasarathy, Sairam; Redolfi, Stefania; Kasai, Takatoshi; Parati, Gianfranco; Delgado, Diego; Bradley, T. Douglas

doi:10.1002/ejhf.790

Cited by 106 publications

(74 citation statements)

References 52 publications

(63 reference statements)

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“…7 Entry criteria included: (1) men or women 18 years of age of older; (2) American Heart Association stages B, C, and D HF due to ischemic, idiopathic, or hypertensive causes for at least 3 months; (3) reduced LVEF (≤ 45%), as determined by twodimensional echocardiography; (4) on optimal medical therapy conforming to contemporary national or American Heart Association guidelines, as determined by the patient's cardiologist; (5) presence of CSR-CSA during the baseline sleep study, defined as apnea-hypopnea index (AHI) ≥ 15 with ≥ 50% of events central in nature and a crescendo-decrescendo pattern of hyperpnea. The exclusion criteria were: (1) HF due to primary valvular heart disease, (2) presence of a left ventricular assistive device, (3) transplanted heart or expected to receive a transplanted heart within the next 6 months, (4) pregnancy, (5) current use of adaptive servoventilation, or continuous or bilevel positive airway pressure.…”

Section: Subjectsmentioning

confidence: 99%

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Perger

Inami

Lyons

et al. 2017

Journal of Clinical Sleep Medicine

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Section: Subjectsmentioning

confidence: 99%

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Perger

Inami

Lyons

et al. 2017

Journal of Clinical Sleep Medicine

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“…ADVENT-HF (a multicenter, randomized study to assess the effects of ASV on survival and frequency of cardiovascular hospital admissions in patients with HF and sleep apnea) is a randomized, parallel-group, open-label trial engaging centers with precertified sleep and echocardiography laboratories located in Canada, the USA, Brazil, Spain, Germany, Italy, England, France and Japan, designed to assess the effect of treating SDB with a peak-airflow triggered ASV (pf-ASV) algorithm on morbidity and mortality of patients with HFrEF. 83 The results of observational and short-term small-sized randomized trials with surrogate endpoints published by 2009, when ADVENT-HF was conceived, signaled the potential for reduced cardiovascular events and improved survival if HFrEF patients were provided effective treatment of both sleep-related breathing disorders. It was generally acknowledged, however, that clinically-indicated treatment should not be denied those patients describing excessive daytime sleepiness.…”

Section: Advent-hf: a Pivotal Hf Trialmentioning

confidence: 99%

Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―

Haruki

Floras

2017

Circ J

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for their deployment can be advocated (Table). However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure (PAP) was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, 7 and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. 3 Consequently, equipoise remains as to whether either OSA or CSA, once detected in a HF patient with reduced left ventricular ejection fraction (LVEF), should be therapeutically suppressed. The threefold purpose of this review was to: (1) summarize current knowledge concerning the prevalence, pathophysiology, and prognostic implications of SDB in HF in support of treatment; (2) examine and reflect upon the results of randomized controlled trials evaluating the effect of treating OSA or CSA on cardiovascular endpoints and mortality; and (3) illustrate how ADVENT-HF, a randomized controlled trial designed to determine the effect of treating HF patients with either CSA or nonsleepy OSA using a peak-airflow triggered ASV algorithm, could resolve the present clinical equipoise concerning the treatment of one or both forms of SDB.A fundamental and as yet unresolved question for the heart failure (HF) community is whether coexisting obstructive (OSA) or central sleep apnea (CSA) should be specific targets of therapy. For individuals without HF, the principal clinical indication to treat sleep apnea is to improve quality of life (QOL) and avert accidental injury or death by alleviating daytime hypersomnolence. However, this indication does not pertain to the majority of patients with reduced left ventricular systolic function and sleep-disordered breathing (SDB) as they are not burdened by excess daytime sleepiness. 1-3 In such individuals, the impetus to diagnosis and treatment is the hypothesis that attenuation or abolition of SDB will modify beneficially the natural history of HF.OSA and CSA interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. 4-6 Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute consequences of such stimuli or on the long-term structural and functional adaptations they induce within the atria and ventricles, the brain and the peripheral vasculature, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. Importantly, effective treatment is presently available for both OSA and CSA and cogent reasons Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt brea...

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“…57 Ultimately, further trials will be required to mediate these discrepant results, and studies with newer generation ASV devices in HFrEF and SDB are ongoing. 58 …”

Section: Central Sleep Apneamentioning

confidence: 99%

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

Valika¹,

Costanzo²

2017

Cardiac Failure Review

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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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Design of the effect of adaptive servo‐ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT‐HF trial

Abstract: The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

Cited by 106 publications

References 52 publications

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―

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

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Design of the effect of adaptive servo‐ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT‐HF trial

Abstract: The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

Cited by 106 publications

References 52 publications

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure

Sleep-Disordered Breathing in Heart Failure ― A Therapeutic Dilemma ―

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

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Product

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Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―