A New Device for Central Sleep Apnea in HF Patients?

Sleep-disordered breathing (central or obstructive) is common in patients with heart failure (HF) and is associated with adverse consequences. A study of ventilatory support with continuous positive airway pressure (CPAP) in patients with central apnea and HF was inconclusive but had suggestive post-hoc subgroup findings of possible benefits when the apnea-hypopnea index (AHI) was greatly reduced. In a manufacturer-sponsored, randomized, controlled trial, investigators have now assessed servo-controlled inspiratory pressure combined with expiratory positive pressure support.

The 1325 participants had chronic symptomatic systolic HF, predominantly class III symptoms, an AHI of ≥15 events per hour, and ≥10 central events per hour (mean age, 69; mean left ventricular ejection fraction [LVEF], 32%). All patients received guideline-based HF therapy. Intervention recipients were asked to use the device ≥5 hours nightly.

Treatment was effective at reducing AHI (mean: baseline, 31.2 events/hour; 12 months, 6.6 events/hour). However, at a mean follow-up of 31 months, the groups showed no differences in time to the primary composite endpoint of death, lifesaving cardiovascular intervention, or unplanned HF hospitalization (intervention, 54.1%; control, 50.8%). Deaths from any cause were significantly more common with the intervention (34.8% vs. 29.3%), reflecting its higher rate of cardiovascular deaths. In both groups, 6-minute walk test distances declined, but to a greater extent with the intervention.