Cowie, Martin R., Woehrle, Holger, Wegscheider, Karl, Angermann, Christiane, d'Ortho, Marie-Pia, Erdmann, Erland, Levy, Patrick, Simonds, Anita K., Somers, Virend K., Zannad, Faiez and Teschler, Helmut (2015). Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N. Engl. J. Med., 373 (12). S. 1095 - 1106. WALTHAM: MASSACHUSETTS MEDICAL SOC. ISSN 1533-4406

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Abstract

BACKGROUND Central sleep apnea is associated with poor prognosis and death in patients with heart failure. Adaptive servo-ventilation is a therapy that uses a noninvasive ventilator to treat central sleep apnea by delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure. We investigated the effects of adaptive servo-ventilation in patients who had heart failure with reduced ejection fraction and predominantly central sleep apnea. METHODS We randomly assigned 1325 patients with a left ventricular ejection fraction of 45% or less, an apnea-hypopnea index (AHI) of 15 or more events (occurrences of apnea or hypopnea) per hour, and a predominance of central events to receive guideline-based medical treatment with adaptive servo-ventilation or guideline-based medical treatment alone (control). The primary end point in the time-to-event analysis was the first event of death from any cause, lifesaving cardiovascular intervention (cardiac transplantation, implantation of a ventricular assist device, resuscitation after sudden cardiac arrest, or appropriate lifesaving shock), or unplanned hospitalization for worsening heart failure. RESULTS In the adaptive servo-ventilation group, the mean AHI at 12 months was 6.6 events per hour. The incidence of the primary end point did not differ significantly between the adaptive servo-ventilation group and the control group (54.1% and 50.8%, respectively; hazard ratio, 1.13; 95% confidence interval [CI], 0.97 to 1.31; P = 0.10). All-cause mortality and cardiovascular mortality were significantly higher in the adaptive servo-ventilation group than in the control group (hazard ratio for death from any cause, 1.28; 95% CI, 1.06 to 1.55; P = 0.01; and hazard ratio for cardiovascular death, 1.34; 95% CI, 1.09 to 1.65; P = 0.006). CONCLUSIONS Adaptive servo-ventilation had no significant effect on the primary end point in patients who had heart failure with reduced ejection fraction and predominantly central sleep apnea, but all-cause and cardiovascular mortality were both increased with this therapy.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Cowie, Martin R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woehrle, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wegscheider, KarlUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Angermann, ChristianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
d'Ortho, Marie-PiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erdmann, ErlandUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Levy, PatrickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Simonds, Anita K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Somers, Virend K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zannad, FaiezUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Teschler, HelmutUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-392901
DOI: 10.1056/NEJMoa1506459
Journal or Publication Title: N. Engl. J. Med.
Volume: 373
Number: 12
Page Range: S. 1095 - 1106
Date: 2015
Publisher: MASSACHUSETTS MEDICAL SOC
Place of Publication: WALTHAM
ISSN: 1533-4406
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
POSITIVE AIRWAY PRESSURE; CHEYNE-STOKES RESPIRATION; CARDIOVASCULAR-DISEASE; BLOOD-PRESSURE; DYSFUNCTION; MORTALITY; MULTICENTER; TRIALMultiple languages
Medicine, General & InternalMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/39290

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