Abstract 3594: Randomized Trial of Adaptive Servo-ventilation Compared versus Continuous Positive Airway Pressure in Chronic Heart Failure Patients With Sleep Apnea: Japanese Trial to Assess the Effect of Adaptive Servo-ventilation in Chronic Heart Failure (JASV)
Background: In patients with chronic heart failure (CHF), the presence of central sleep apnea (CSA) is associated with a poor prognosis. A large-scale clinical trial showed that continuous positive airway pressure (CPAP) did not improve the prognosis of such CHF patients probably due to insufficient CSA suppression. It was reported that adaptive servo-ventilation (ASV) can effectively suppress CSA. However, there are few data about the efficacy of ASV for cardiac function in CHF patients with coexisting obstructive sleep apnea (OSA) and CSA.
Methods: Thirty-one patients with CHF, defined as left ventricular ejection fraction (LVEF) <50% and New York Heart Association (NYHA) class ≥II, with coexisting OSA and CSA, were randomly assigned to either CPAP or ASV. The suppression of respiratory events, changes in cardiac function, quality of life and compliance with the devices during the 3-month study period were compared.
Results: Although both devices decreased respiratory events, ASV more effectively suppressed respiratory events (ΔAHI, -35.4±19.5 with ASV, −23.2±12.0 with CPAP, P<0.05). Compliance was significantly greater with ASV than with CPAP (5.2±0.9 versus 4.4±1.1 h/night, P<0.05). The improvement in quality of life, 6 minutes walk distance and LVEF was significantly greater in the ASV group (Δ6 minutes walk distance, 34.0±42.7 versus −8.7±70.1, P<0.01, ΔLVEF, +9.1%±4.7% versus +1.9%±10.9 %, P<0.05).
Conclusions: These results suggest that patients with coexisting OSA and CSA may receive greater benefit from treatment with ASV than with CPAP.