Promising effects of adaptive servoventilation in heart failure with sleep apnea

In his PhD thesis, Arild Hetland shows that heart function, quality of life and possibly survival improve in heart failure patients who treat central sleep apnea with adaptive servoventilation (ASV) at night.


MAIN RESULTS:

  1. ASV improves heart function and functional capacity in patients with chronic heart failure and Cheyne-Stokes respiration.
  2. Patients treated with ASV lived longer than those not treated with ASV.
  3. Discontinuation of ASV reduces sleep quality and quality of life.

THESIS DEFENCE:

Thesis: Adaptive servo-ventilation as supplemental  treatment in patients with chronic heart failure and Cheyne- Stokes respiration
Candidate: Arild Hetland
Time: June 14, 2018 at 13:15
Place: Oslo University Hospital, Rikshospitalet: Seminar room 2
Link to university website (in Norwegian)


SUMMARY:

ASV is a novel therapy in patients with congestive heart failure suffering from central sleep apnea with Cheyne-Stokes respiration. ASV is a mask that helps the patients breath during the night.

(1) 15 patients randomized to ASV improved left ventricular ejection fraction, performance at a six-minute walk test, and NYHA class after three months treatment. The patients in the control group had no such improvements.

(2) Patients with heart failure and central sleep apnea treated with ASV could live longer and reduce the risk of hospitalization. After 18 months, only two out of 36 patients (6 %) in the ASV group had died, compared to 25 % in the control group. Furthermore, there was a clear trend of reduced hospitalization rates and reduced length of hospital stays in the ASV group. Hetland and co-workers point out that the promising results must be interpreted with caution, as they contradict the results from a much larger international trial.

(3) In patients who discontinued use of ASV for three months, the number of apnea and hypopnea events per hour of sleep increased from a mean of 1.6 to 39.2. Furthermore, the patients reported lower quality of life and more shortness of breath, as well as reduced concentration and memory, compared to when using the mask. 14 patients were included in the study. Left ventricular ejection fraction, functional capacity and heart rate did not change following three months discontinuation of ASV.


REFERENCES:

(1) Hetland, A., Haugaa, K. H., Olseng, M., Gjesdal, O., Ross, S., Saberniak, J., Jacobsen, M. B., & Edvardsen, T. (2013). Three-month treatment with adaptive servoventilation improves cardiac function and physical activity in patients with chronic heart failure and cheyne-stokes respiration: a prospective randomized controlled trialCardiology126(2), 81-90.

(2) Hetland, A., Haugaa, K. H., Vistnes, M., Liland, K. H., Olseng, M., Jacobsen, M. B., & Edvardsen, T. (2017). A retrospective analysis of cardiovascular outcomes in patients treated with ASVScandinavian Cardiovascular Journal51(2), 106-113.

(3) Hetland, A., Lerum, T. V., Haugaa, K. H., & Edvardsen, T. (2017). Patients with Cheyne–Stokes respiration and heart failure: patient tolerance after three-month discontinuation of treatment with adaptive servo-ventilationHeart and vessels32(8), 909-915.