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Sleep Disordered Breathing and Congestive Heart Failure

The association between sleep disordered breathing and congestive heart failure (CHF) is well established (1, 2) but the optimal treatment remains elusive.

Oxygen, continuous positive pressure (CPAP), bi-level positive pressure, and most recently adaptive servo-ventilation (ASV) have all been proposed as potential therapies. ASV has gained popularity and shown to be effective in reducing the apnea hypopnea index and improving sleep architecture (3, 4). The use of ASV in patients with symptomatic heart failure, low ejection fraction, and central sleep apnea came to an abrupt halt in 2015 with the announcement of the preliminary results from the SERVE-HF study and the subsequent publication of study findings.(5)

SERVE-HF is a multi-center randomized controlled trial of individuals with symptomatic congestive heart failure (left ventricular ejection fraction ≤ 45%) and predominately central sleep apnea, treated with ASV or optimal medical therapy; all-cause and cardiovascular mortality were significantly higher in the ASV group than in the control group.

In this podcast, Dr. Shirin Shafazand chats with Dr. Douglas Bradley, a respirologist, Professor of Medicine and Director of the Division of Respirology, and of the Centre for Sleep Medicine and Circadian Biology at the University of Toronto. Dr. Bradley is well known for his research on sleep disordered breathing and heart failure and is currently the Director of a multi-national randomized clinical trial (The ADVENT-HF Trial) to determine whether treating sleep apnea in patients with heart failure will reduce morbidity and mortality. Dr. Bradley discusses the results of the SERVE-HF trial, considers possible reasons for the study findings, and makes recommendations for the treatment of sleep disordered breathing in patients with CHF.

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  1. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 1999; 99(20): 2709–2712.

  2. MacDonald M, Fang J, Pittman SD, White DP, Malhotra A., The current prevalence of sleep disordered breathing in congestive heart failure patients treated with beta-blockers. J Clin Sleep Med. 2008 Feb 15;4(1):38-42.

  3. Wu X, Fu C, Zhang S, Liu Z, Li S, Jiang L. Adaptive servoventilation improves cardiac dysfunction and prognosis in heart failure patients with sleep-disordered breathing: a meta-analysis. Clin Respir J. 2015 Sep 25. doi: 10.1111 (Epub ahead of print)

  4. Hetzenecker A, Roth T, Birner C, Maier LS, Pfeifer M, Arzt M. Adaptive servo-ventilation therapy of central sleep apnoea and its effect on sleep quality. Clin Res Cardiol. 2015 Sep 5. (Epub ahead of print)

  5. Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. N Engl J Med 2015; 373:1095-1105.