Adaptive servo-ventilation to treat central sleep apnea in heart failure with reduced ejection fraction: the Bad Oeynhausen prospective ASV registry

  • Olaf Oldenburg
  • Birgit Wellmann
  • Thomas Bitter
  • Henrik Fox
  • Anika Buchholz
  • Eric Freiwald
  • Dieter Horstkotte
  • Karl Wegscheider
Original Paper
  • 19 Downloads

Abstract

Background

Central sleep apnea (CSA) is highly prevalent in heart failure patients with reduced left ventricular ejection fraction (HF-REF). The Bad Oeynhausen Adaptive Servo-ventilation (ASV) registry (NCT01657188) was designed to investigate whether treatment of CSA with ASV improved survival in HF-REF patients; the effects of ASV on symptoms and cardiopulmonary performance were also investigated.

Methods and results

From January 2004 to October 2013, the registry prospectively enrolled HF-REF patients [NYHA class ≥ II, left ventricular ejection fraction (LVEF) ≤ 45%] with moderate to severe predominant CSA [apnea–hypopnea index (AHI) ≥ 15/h]. ASV-treated patients were followed up at 3, 6, 12 and 24 months, including natriuretic peptide concentrations, blood gas analyses, echocardiography, 6-min walk distance (6MWD), and cardiopulmonary exercise (CPX) testing. 550 patients were included [age 67.7 ± 10 years, 90% male, 52% in NYHA class ≥ III, LVEF 29.9 ± 8%, AHI 35.4 ± 13.6/h, and time with nocturnal oxygen saturation < 90% (T < 90%) 58 ± 73 min]; ASV was prescribed to 224 patients. Over a median follow-up of 6.6 years, 109 (48.7%) ASV-treated patients and 191 (58.6%) controls died (adjusted Cox modelling hazard ratio of 0.95, 95% confidence interval 0.68–1.24; p = 0.740); older age, lower LVEF, impaired renal function, low sodium concentration, and nocturnal hypoxemia were significant predictors of mortality. Patient reported NYHA functional class improved in the ASV group, but LVEF, CPX, 6MWD, natriuretic peptides and blood gases remained unchanged.

Conclusions

Long-term ASV treatment of predominant CSA in HF-REF patients included in our registry had no statistically significant effect on survival. ASV improved HF symptoms, but had no significant effects on exercise capacity, LVEF, natriuretic peptide concentrations or blood gases during follow-up as compared to control patients.

Keywords

Central sleep apnea Sleep-disordered breathing Mortality Heart failure Adaptive servo-ventilation 

Notes

Acknowledgements

English language editing assistance was provided by Nicola Ryan, independent medical writer, funded by ResMed.

Compliance with ethical standards

Conflict of interest

O. Oldenburg, T. Bitter, and K. Wegscheider report personal fees from ResMed; A. Buchholz reports grants from ResMed and Biotronik, personal fees from Boston Scientific; and H. Fox, E. Freiwald, B. Wellmann, and D. Horstkotte have no conflicts of interest to disclose.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Olaf Oldenburg
    • 1
  • Birgit Wellmann
    • 2
  • Thomas Bitter
    • 1
  • Henrik Fox
    • 1
  • Anika Buchholz
    • 3
  • Eric Freiwald
    • 3
  • Dieter Horstkotte
    • 1
  • Karl Wegscheider
    • 3
  1. 1.Clinic for Cardiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität BochumBad OeynhausenGermany
  2. 2.Department of Clinical Studies in CardiologyHerz-und Diabeteszentrum NRW, Ruhr-Universität BochumBad OeynhausenGermany
  3. 3.Department of Medical Biometry and EpidemiologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany

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