Adaptive servo-ventilation (ASV) is a noninvasive therapy utilized to manage central sleep apnea, particularly in patients with heart failure. This treatment employs a ventilator to deliver servo-controlled inspiratory pressure support alongside expiratory positive airway pressure. While initially considered a promising approach, recent research has shed light on potential risks associated with Servo Ventilator use in specific patient populations.
A significant study, the SERVE-HF trial, investigated the effectiveness and safety of adaptive servo-ventilation in patients suffering from heart failure with reduced ejection fraction and predominantly central sleep apnea. The study randomly assigned 1325 such patients to either receive guideline-based medical treatment with adaptive servo-ventilation or guideline-based medical treatment alone as a control group. The primary endpoint was defined as the first occurrence of death from any cause, a life-saving cardiovascular intervention, or unplanned hospitalization due to worsening heart failure.
The results of the SERVE-HF trial indicated that adaptive servo-ventilation did not significantly reduce the incidence of the primary endpoint. In fact, there was no statistically significant difference between the ASV group and the control group (54.1% vs 50.8%, hazard ratio 1.13, P=0.10). More concerningly, the study revealed a significant increase in both all-cause mortality and cardiovascular mortality in the group treated with adaptive servo-ventilation compared to the control group. The hazard ratio for death from any cause was 1.28 (P=0.01), and for cardiovascular death, it was 1.34 (P=0.006). This suggests that servo ventilator therapy, in this specific patient population, may be associated with adverse outcomes.
The SERVE-HF trial concluded that adaptive servo-ventilation, while effectively treating central sleep apnea as evidenced by a mean Apnea-Hypopnea Index (AHI) reduction to 6.6 events per hour at 12 months in the ASV group, does not provide clinical benefit in heart failure patients with reduced ejection fraction and central sleep apnea. Furthermore, the increased mortality rates observed raise serious concerns about the routine use of servo ventilators in this context. These findings underscore the importance of careful patient selection and a thorough understanding of the potential risks and benefits when considering adaptive servo-ventilation for central sleep apnea in heart failure patients.
References:
- SERVE-HF ClinicalTrials.gov number: NCT00733343
