Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Arzt M, Woehrle H, Oldenburg O, Graml A, Suling A, Erdmann E, Teschler H, Wegscheider K, Schla HFI (2016) Prevalence and predictors of sleep-disordered breathing in patients with stable chronic heart failure: the SchlaHF registry. JACC Heart Fail 4(2):116–125. https://doi.org/10.1016/j.jchf.2015.09.014

    Article  PubMed  Google Scholar 

  2. Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Topfer V (2007) Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 9(3):251–257. https://doi.org/10.1016/j.ejheart.2006.08.003

    Article  PubMed  Google Scholar 

  3. Strotmann J, Fox H, Bitter T, Schindhelm F, Gutleben KJ, Horstkotte D, Oldenburg O (2017) Predominant obstructive or central sleep apnea in patients with atrial fibrillation: influence of characterizing apneas versus apneas and hypopneas. Sleep Med 37:66–71. https://doi.org/10.1016/j.sleep.2017.06.003

    Article  PubMed  Google Scholar 

  4. Oldenburg O (2012) Cheyne-Stokes respiration in chronic heart failure. Treatment with adaptive servoventilation therapy. Circ J 76(10):2305–2317

    Article  PubMed  Google Scholar 

  5. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med JCSM 5(3):263–276

    PubMed  Google Scholar 

  6. Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Galetke W, Maurer JT, Orth M, Penzel T, Pistner HP, Randerath W, Rosslein M, Sitter H, Stuck BA (2017) S3-Leitlinie nicht erholsamer schlaf/schlafstörungen – kapitel “schlafbezogene atmungsstörungen”. Deutsche gesellschaft für schlafforschung und schlafmedizin (DGSM). Somnologie 20(Suppl s2):S97–S180

    Google Scholar 

  7. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128

    Article  PubMed  Google Scholar 

  8. Franklin KA (2007) Sleep apnoea screening in heart failure? Not until benefit is proven! Eur Respir J 29(6):1073–1074. https://doi.org/10.1183/09031936.00030507

    Article  PubMed  CAS  Google Scholar 

  9. Naughton MT (2012) Cheyne-stokes respiration: friend or foe? Thorax 67(4):357–360. https://doi.org/10.1136/thoraxjnl-2011-200927

    Article  PubMed  Google Scholar 

  10. Oldenburg O, Coats A (2017) csa is not beneficial long term in heart failure patients with reduced ejection fraction. Int J Cardiol 227:474–477. https://doi.org/10.1016/j.ijcard.2016.11.003

    Article  PubMed  Google Scholar 

  11. Damy T, Margarit L, Noroc A, Bodez D, Guendouz S, Boyer L, Drouot X, Lamine A, Paulino A, Rappeneau S, Stoica MH, Dubois-Rande JL, Adnot S, Hittinger L, d’Ortho MP (2012) Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 14(9):1009–1019. https://doi.org/10.1093/eurjhf/hfs085

    Article  PubMed  Google Scholar 

  12. Javaheri S, Shukla R, Zeigler H, Wexler L (2007) Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol 49(20):2028–2034. https://doi.org/10.1016/j.jacc.2007.01.084

    Article  PubMed  Google Scholar 

  13. Oldenburg O, Wellmann B, Buchholz A, Bitter T, Fox H, Thiem U, Horstkotte D, Wegscheider K (2016) Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J 37(21):1695–1703. https://doi.org/10.1093/eurheartj/ehv624

    Article  PubMed  Google Scholar 

  14. Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Ryan C, Tomlinson G, Bradley TD, Investigators C (2007) Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian continuous positive airway pressure for patients with central sleep apnea and heart failure trial (CANPAP). Circulation 115(25):3173–3180. https://doi.org/10.1161/CIRCULATIONAHA.106.683482

    Article  PubMed  Google Scholar 

  15. Teschler H, Dohring J, Wang YM, Berthon-Jones M (2001) Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med 164(4):614–619. https://doi.org/10.1164/ajrccm.164.4.9908114

    Article  PubMed  CAS  Google Scholar 

  16. Oldenburg O, Fox H, Bitter T, Horstkotte D (2017) Adaptive servoventilation to treat sleep-disordered breathing in cardiac patients. Somnologie 21(1):82–83. https://doi.org/10.1007/s11818-017-0100-1

    Article  Google Scholar 

  17. Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho MP, Erdmann E, Levy P, Simonds A, Somers VK, Zannad F, Teschler H (2013) Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure. Eur J Heart Fail 15(8):937–943. https://doi.org/10.1093/eurjhf/hft051

    Article  PubMed  PubMed Central  Google Scholar 

  18. Oldenburg O, Bitter T, Lehmann R, Korte S, Dimitriadis Z, Faber L, Schmidt A, Westerheide N, Horstkotte D (2011) Adaptive servoventilation improves cardiac function and respiratory stability. Clin Res Cardiol 100(2):107–115. https://doi.org/10.1007/s00392-010-0216-9

    Article  PubMed  Google Scholar 

  19. Cowie MR, Woehrle H, Wegscheider K, Angermann C, d’Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H (2015) Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med 373(12):1095–1105. https://doi.org/10.1056/NEJMoa1506459

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Woehrle H, Cowie MR, Eulenburg C, Suling A, Angermann C, d’Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H, Wegscheider K (2017) Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis. Eur Respir J. https://doi.org/10.1183/13993003.01692-2016

    Article  PubMed Central  PubMed  Google Scholar 

  21. Oldenburg O, Faber L, Vogt J, Dorszewski A, Szabados F, Horstkotte D, Lamp B (2007) Influence of cardiac resynchronisation therapy on different types of sleep disordered breathing. Eur J Heart Fail 9(8):820–826. https://doi.org/10.1016/j.ejheart.2007.03.009

    Article  PubMed  Google Scholar 

  22. Eulenburg C, Wegscheider K, Woehrle H, Angermann C, d’Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H, Cowie MR (2016) Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysis. Lancet Respir Med 4(11):873–881. https://doi.org/10.1016/S2213-2600(16)30244-2

    Article  PubMed  Google Scholar 

  23. Oldenburg O, Horstkotte D (2015) Heart failure: central sleep apnoea in HF–what can we learn from SERVE-HF? Nat Rev Cardiol 12(12):686–687. https://doi.org/10.1038/nrcardio.2015.168

    Article  PubMed  Google Scholar 

  24. Javaheri S, Brown LK, Randerath W, Khayat R (2016) SERVE-HF: more questions than answers. Chest 149(4):900–904. https://doi.org/10.1016/j.chest.2015.12.021

    Article  PubMed  Google Scholar 

  25. Kihara Y, Seino Y, Momomura S (2016) Adaptive servo-ventilation for central sleep apnea in heart failure. N Engl J Med 374 (7):687–688. https://doi.org/10.1056/NEJMc1515007#SA1

    Article  PubMed  Google Scholar 

  26. Linz D, Fox H, Bitter T, Spiesshofer J, Schobel C, Skobel E, Turoff A, Bohm M, Cowie MR, Arzt M, Oldenburg O (2016) Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies. Clin Res Cardiol 105(7):563–570. https://doi.org/10.1007/s00392-016-0970-4

    Article  PubMed  CAS  Google Scholar 

  27. Fox H, Witzel S, Bitter T, Horstkotte D, Oldenburg O (2017) Positive airway pressure therapy in heart failure patients: long-term effects on lung function. Respir Physiol Neurobiol 238:41–46. https://doi.org/10.1016/j.resp.2017.01.010

    Article  PubMed  Google Scholar 

  28. Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Tomlinson G, Floras JS, Investigators C (2005) Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 353(19):2025–2033. https://doi.org/10.1056/NEJMoa051001

    Article  PubMed  CAS  Google Scholar 

  29. Momomura S, Seino Y, Kihara Y, Adachi H, Yasumura Y, Yokoyama H, Wada H, Ise T, Tanaka K, Investigators S-C (2015) Adaptive servo-ventilation therapy for patients with chronic heart failure in a confirmatory, multicenter, randomized, controlled study. Circ J 79 (5):981–990. https://doi.org/10.1253/circj.CJ-15-0221

    Article  PubMed  Google Scholar 

  30. Arzt M, Pfeifer M, Schroll S (2014) Is auto-servoventilation unnecessary in patients with heart failure and apnoea? Eur Respir J 44(2):551–553. https://doi.org/10.1183/09031936.00057114

    Article  PubMed  Google Scholar 

  31. O’Connor CM, Whellan DJ, Fiuzat M, Punjabi NM, Tasissa G, Anstrom KJ, Benjafield AV, Woehrle H, Blase AB, Lindenfeld J, Oldenberg O (2017) Cardiovascular outcomes with minute ventilation-targeted adaptive servo-ventilation therapy in heart failure: the CAT-HF trial. J Am Coll Cardiol 69(12):1577–1587. https://doi.org/10.1016/j.jacc.2017.01.041

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Funding

This work was supported by ResMed Ltd, Sydney, Australia.

Author information

Authors and Affiliations

  1. Clinic for Cardiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Olaf Oldenburg, Thomas Bitter, Henrik Fox & Dieter Horstkotte

  2. Department of Clinical Studies in Cardiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany

    Birgit Wellmann

  3. Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

    Anika Buchholz, Eric Freiwald & Karl Wegscheider

Authors
  1. Olaf Oldenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Birgit Wellmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Bitter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henrik Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anika Buchholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Freiwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dieter Horstkotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Karl Wegscheider
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olaf Oldenburg.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oldenburg, O., Wellmann, B., Bitter, T. et al. Adaptive servo-ventilation to treat central sleep apnea in heart failure with reduced ejection fraction: the Bad Oeynhausen prospective ASV registry. Clin Res Cardiol 107, 719–728 (2018). https://doi.org/10.1007/s00392-018-1239-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-018-1239-x

Keywords

Search

Navigation