- Question
- Does adaptive servo-ventilation improve clinical outcomes in patients with heart failure with reduced ejection fraction and predominantly central sleep apnea?
- Design
- Randomized, open-label (unmasked) trial of 1325 patients assigned to guideline-based medical treatment with or without adaptive servo-ventilation. The analysis was time to first event.
- Population
- Patients with a left ventricular ejection fraction of 45% or less, an apnea-hypopnea index of 15 or more events per hour, and a predominance of central events.
- Intervention
- Adaptive servo-ventilation, delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure, added to guideline-based medical treatment.
- Control
- Guideline-based medical treatment alone (control group).
- Primary outcome
- First event of death from any cause, lifesaving cardiovascular intervention (cardiac transplantation, ventricular assist device, resuscitation after sudden cardiac arrest, or appropriate lifesaving shock), or unplanned hospitalization for worsening heart failure.
- Results
- The primary end point did not differ significantly between groups (54.1% with adaptive servo-ventilation vs 50.8% in controls; HR 1.13; 95% CI 0.97 to 1.31; P=0.10). Mean apnea-hypopnea index at 12 months was 6.6 events per hour in the treated group. All-cause mortality was higher with adaptive servo-ventilation (HR 1.28; 95% CI 1.06 to 1.55; P=0.01), as was cardiovascular mortality (HR 1.34; 95% CI 1.09 to 1.65; P=0.006).
- Conclusion
- Adaptive servo-ventilation had no significant effect on the primary end point and was associated with higher all-cause and cardiovascular mortality in these patients.
- Why it matters
- The trial showed that treating central sleep apnea with adaptive servo-ventilation in heart failure with reduced ejection fraction not only fails to help but may cause harm, discouraging use of this therapy in this population.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026