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Original Research: Sleep Disorders |

Adaptive Servoventilation for Treatment of Sleep-Disordered Breathing in Heart FailureAdaptive Servoventilation in Heart Failure: A Systematic Review and Meta-analysis

Bhavneesh K. Sharma, MD; Jessie P. Bakker, PhD; David G. McSharry, MB; Akshay S. Desai, MD, MPH; Shahrokh Javaheri, MD, FCCP; Atul Malhotra, MD, FCCP
Author and Funding Information

From Steward Health Care System (Dr Sharma), Boston, MA; Sleep Disorders Research Program (Drs Bakker, McSharry, and Malhotra), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; Cardiovascular Division (Dr Desai), Brigham and Women’s Hospital, Boston, MA; and Sleepcare Diagnostics (Dr Javaheri), Cincinnati, OH.

Correspondence to: Jessie P. Bakker, PhD, Sleep Disorders Research Program, 221 Longwood Ave 036BLI, Boston, MA 02115; e-mail: jpbakker@partners.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: Dr. Bakker does not have any current funding to disclose. Dr McSharry is supported by the American Heart Association (AHA) [11POST5660004]. Dr Malhotra is supported by the US National Institutes of Health [Grants 5R01HL085188-04, 5R01HL090897-03, 5K24HL093218-03, and 1P01HL095491-01A1] and the AHA [grant 0840159N], but has relinguished all outside personal income since May 2012. No financial support was obtained for this investigation.


Chest. 2012;142(5):1211-1221. doi:10.1378/chest.12-0815
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Background:  Adaptive servoventilation (ASV) has demonstrated efficacy in treating sleep-disordered breathing (SDB) in patients with heart failure (HF), but large randomized trials are lacking. We, therefore, sought to perform a systematic review and meta-analysis of existing data.

Methods:  A systematic search of the PubMed database was undertaken in March 2012. Publications were independently assessed by two investigators to identify studies of ≥ 1-week duration that compared ASV to a control condition (ie, subtherapeutic ASV, continuous or bilevel pressure ventilation, oxygen therapy, or no treatment) in adult patients with SDB and HF. Mean, variability, and sample size data were extracted independently for the following outcomes: apnea-hypopnea index (AHI), left ventricular ejection fraction (LVEF), quality of life (SF-36 Health Survey; Medical Outcomes Trust), 6-min walk distance, peak oxygen consumption (V˙ o2) % predicted, and ventilatory equivalent ratio for CO2 (V˙ e/V˙ co2) slope measured during exercise. Random effects meta-analysis models were applied.

Results:  Fourteen studies were identified (N = 538). Comparing ASV to control conditions, the weighted mean difference in AHI (−14.64 events/h; 95% CI, −21.03 to −8.25) and LVEF (0.40; 95% CI, 0.08-0.71) both significantly favored ASV. ASV also improved the 6-min walk distance, but not peak V˙ o2 % predicted, V˙ e/V˙ co2 slope, or quality of life, compared with control conditions.

Conclusions:  In patients with HF and SDB, ASV was more effective than control conditions in reducing the AHI and improving cardiac function and exercise capacity. These data provide a compelling rationale for large-scale randomized controlled trials to assess the clinical impact of ASV on hard outcomes in these patients.

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