Effectiveness of Adaptive Servo-Ventilation for Treating Heart Failure Regardless of the Severity of Sleep-Disordered Breathing

Abstract

Background: It is unclear whether adaptive servo-ventilation (ASV) is effective for all patients with heart failure (HF). The aim of the present study was therefore to investigate the effectiveness of ASV for all patients with HF. Methods and Results:Sixty-one patients with HF were recommended for ASV treatment, regardless of sleepdisordered breathing (SDB) severity and type. On the basis of the apnea - hypopnea index (AHI) results, patients were classified into 3 groups: 28 patients with AHI ≥40/h were designated as group A; 20 patients with AHI ≥20/h and <40/h were designated as group B; and 13 patients with AHI <20/h were designated as group C. After ASV treatment, brain natriuretic peptide (BNP) levels and left ventricular ejection fraction (LVEF) were improved almost equally in the 3 groups (changes in BNP level: group A, -313±480 pg/ml; group B, -401±801 pg/ml; group C, -225± 240 pg/ml; P=0.69; changes in LVEF: group A, 8.5±11.3%; group B, 10.5±9.6%; group C, 2.4±12.4%; P=0.17). Conclusions:ASV treatment for patients with mild SDB resulted in almost equal improvements in BNP levels and LVEF compared to that in patients with moderate and severe SDB, demonstrating that ASV is effective for all patients with HF. (Circ J 2011; 75: 1164 - 1169

‘A Single Night’ Beneficial Effects of Adaptive Servo-Ventilation on Cardiac Overload, Sympathetic Nervous Activity, and Myocardial Damage in Patients With Chronic Heart Failure and Sleep-Disordered Breathing

“…There are several reports about a reduction in the BNP level after several months of using ASV. 17,25,29, 30 In the present study, only 'single night' use of ASV directly decreased cardiac overload as demonstrated by significant decreases in the ANP and BNP levels in CHF patients with SDB. This effect by ASV seems to be driven by intrathoracic positive pressure.…”

A Long-Term Prognosis of Adaptive Servo Ventilation Therapy for Patients with Heart Failure -Consideration in Severity of Sleep-Disordered Breathing-

“…However, previously, we reported that ASV therapy for patients with mild SDB resulted in almost equal improvements in brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) compared with patients with moderate and severe SDB, thus demonstrating that ASV therapy was effective for all patients with HF. 9 Similarly, other reports suggested that the ASV therapy improved the LVEF, BNP, and the prognosis of patients with HF. 6,10,11 However, previous reports have suggested that there is a negative relationship between the severity of SDB and prognosis.…”

“…Previously, we reported that ASV treatment for patients with mild SDB resulted in comparable improvements in BNP and LVEF to those for patients with moderate and severe SDB. 9 Koyama et al have also reported that ASV therapy for patients with HF effectively improved the short-term prognosis (again, assessed by LVEF and BNP), irrespective of the SDB severity. 21 Moreover, previous reports have revealed that ASV therapy improved both BNP and LVEF.…”

“…Furthermore, many reports showed that the ASV therapy for the patients with HF was effective. 5,7,9,10,11,[18][19][20][21][22] Although it is well known that the prognosis of patients is negatively correlated with the severity of SDB, 12 little has been reported on the long-term prognosis in patients with HF after initiating ASV therapy. Earlier, we showed that ASV therapy was effective for patients with HF and that it improved their prognosis after one year.…”

Cautions and Strategy for Treating Chronic Heart Failure by Using Adaptive Servo-Ventilation

“…Unfortunately, neither the rate of complications of CSR before the intervention nor the results of the 1-year follow-up evaluation of the improvement on SDB after treatment was described in the authors' previous report. 9 As Brown's review shows, because most studies to date have lacked titration of undergoing PSG at a sleep laboratory and of follow-up examination to estimate the efficacy of ASV for each individual patient, there is no support for physicians to indiscriminately prescribe ASV for unselected patients to use in their home with the device parameters set to default values. 14 Consequently, because ASV is a much more complicated device to use than CPAP, it requires greater concern with regard to prescription and management.…”