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Published in: Sleep and Breathing 1/2020

01-03-2020 | Heart Failure | Sleep Breathing Physiology and Disorders • Review

Use of adaptive servo ventilation therapy as treatment of sleep-disordered breathing and heart failure: a systematic review and meta-analysis

Authors: Adrian V. Hernandez, Anne Jeon, Jack Denegri-Galvan, Fernando Ortega-Loayza, Monica Felix-Moscoso, Vinay Pasupuleti, Roop Kaw

Published in: Sleep and Breathing | Issue 1/2020

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Abstract

Purpose

Adaptive servoventilation (ASV) has been reported to show improvement in patients with sleep-disordered breathing (SDB) and heart failure (HF); however, its role as a second-line or adjunctive treatment is not clear. We conducted a systematic review and meta-analysis of new existing data including cardiac mechanistic factor, geometry, and cardiac biomarkers.

Methods

We systematically searched for randomized controlled trials (RCTs) and cohort studies that assessed the efficacy or effectiveness of ASV compared to conventional treatments for SDB and HF in five research databases from their inception to November 2018. Random-effects meta-analyses using the inverse variance method and stratified by study design were performed.

Results

We included 15 RCTs (n = 859) and 5 cohorts (n = 162) that met our inclusion criteria. ASV significantly improved left ventricular ejection fraction (LVEF) in cohorts (MD 6.96%, 95% CI 2.58, 11.34, p = 0.002), but not in RCTs. Also, the ASV group had significantly lower apnea-hypopnea index (AHI) in both cohorts (MD − 26.02, 95% CI − 36.94, − 15.10, p < 0.00001) and RCTs (MD − 21.83, 95% CI − 28.17, − 15.49, p < 0.00001). ASV did not significantly decrease the E/e′ ratio in RCTs or in cohorts. Finally, ASV significantly decreased brain natriuretic peptide (BNP) in the cohorts (SMD − 121.99, CI 95% − 186.47, − 57.51, p = 0.0002) but not in RCTs. ASV did not have a significant effect on systolic blood pressure, diastolic blood pressure, and cardiac diameters.

Conclusions

ASV therapy is associated with improvements of AHI in comparison to alternative treatments in patients with SDB and HF. ASV did not improve LVEF or E/e′ ratios in randomized trials; other intermediate outcomes did not improve significantly.
Appendix
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Metadata
Title
Use of adaptive servo ventilation therapy as treatment of sleep-disordered breathing and heart failure: a systematic review and meta-analysis
Authors
Adrian V. Hernandez
Anne Jeon
Jack Denegri-Galvan
Fernando Ortega-Loayza
Monica Felix-Moscoso
Vinay Pasupuleti
Roop Kaw
Publication date
01-03-2020
Publisher
Springer International Publishing
Keyword
Heart Failure
Published in
Sleep and Breathing / Issue 1/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-019-01882-8

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