Effects of Auto-Servo Ventilation on Patients with Sleep-Disordered Breathing, Stable Systolic Heart Failure and Concomitant Diastolic Dysfunction: Subanalysis of a Randomized Controlled Trial

Abstract

Background: Systolic heart failure (HF) is frequently accompanied by diastolic dysfunction and sleep-disordered breathing (SDB). Objectives: The objective of this subset analysis was to determine effect sizes of auto-servo ventilation (ASV and biphasic positive airway pressure ASV) on echocardiographic measures of diastolic function in patients with systolic HF and SDB. Methods: Thirty-two patients with stable systolic HF, concomitant diastolic dysfunction [age 66 ± 9 years old, left ventricular (LV) ejection fraction: 30 ± 7% and New York Heart Association class II: 72%] and SDB (apnea-hypopnea index, AHI: 48 ± 19/h; 53% had predominantly obstructive sleep apnea) receiving either ASV (n = 19) or optimal medical treatment (control, n = 13) were analyzed in a randomized controlled clinical trial. Polysomnographic and echocardiographic measurements were obtained at baseline and after 12 weeks. Results: AHI significantly improved in the ASV group compared to the control group (-39 ± 18 vs. -0.2 ± 13.2/h, p < 0.001). At baseline, 24 (75%) patients had impaired LV relaxation, and 8 (25%) had a pseudo-normalized filling pattern. At the 12-week control visit, diastolic function assessed by the isovolumetric relaxation time (-10.3 ± 26.1 vs. 9.3 ± 49.1, p = 0.48) and deceleration time (-43.9 ± 88.8 vs. 12.4 ± 68.8, p = 0.40) tended to improve after ASV treatment, but did not reach statistical significance. Likewise, the proportion of patients whose diastolic dysfunction improved was nonsignificantly higher in the ASV than in the control group, respectively (37 vs. 15%, p = 0.25). Conclusions: ASV treatment efficiently abolishes SDB in patients with stable systolic HF and concomitant diastolic dysfunction, and was associated with a statistically nonsignificant improvement in measures of diastolic dysfunction. Thus, these data provide estimates of effect size and justify the evaluation of the effects of ASV on diastolic function in larger randomized controlled trials.

Ventilation Parameters under Adaptive Servo Ventilation: A Comparison on Behalf of CSA-Pattern, BNP/NT-pro-BNP, and Ejection Fraction

“…Adaptive servoventilation (ASV) has so far been applied to patients with CPAP-resistant and emergent CSA as well as in heart failure patients with Cheyne-Stokes respiration (CSA-CSR) [13][14][15][16][17][18][19]. A number of studies has shown a normalized breathing pattern and even improved exercise capacity in patients with CSA-CSR [16,19,[20][21][22][23].…”

Adaptive servoventilation improves cardiac dysfunction and prognosis in heart failure patients with sleep‐disordered breathing: a meta‐analysis

“…Control groups were sub therapeutic ASV (one study) , CPAP (two studies), BPV (one study) and optimal medical treatment (three studies). Five studies reported clear statements on AHI. Six studies involved outcomes of the LVEF.…”

Reply 2

“…deceleration time, ASV vs no treatment of sleep-disordered breathing: −43.9 ± 88.8 vs 12.4 ± 68.8, P > 0.05). 5 The proportion of patients whose diastolic dysfunction improved was non-significantly higher in the ASV than in the control group, respectively (37% vs 15%, P > 0.05). 5 These data provide estimates of effect size and justify the evaluation of the effects of positive airway pressure therapy on diastolic function in larger randomized controlled trials.…”

“…5 The proportion of patients whose diastolic dysfunction improved was non-significantly higher in the ASV than in the control group, respectively (37% vs 15%, P > 0.05). 5 These data provide estimates of effect size and justify the evaluation of the effects of positive airway pressure therapy on diastolic function in larger randomized controlled trials. However, we did not assess the acute effects of positive airway pressure therapy on diastolic function, which might have complemented the presented data on blood pressure, heart rate and non-invasively assessed cardiac output.…”