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

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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.

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Guarantor statement

Adrian V. Hernandez is the guarantor of the content of the manuscript, including data and analysis.

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Authors and Affiliations

  1. Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA

    Adrian V. Hernandez & Anne Jeon

  2. School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru

    Adrian V. Hernandez, Jack Denegri-Galvan, Fernando Ortega-Loayza & Monica Felix-Moscoso

  3. ProEd Communications, Inc., Cleveland, OH, USA

    Vinay Pasupuleti

  4. Department of Hospital Medicine and Anesthesiology Outcomes Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

    Roop Kaw

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  1. Adrian V. Hernandez
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  2. Anne Jeon
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Contributions

Study concept and design: Denegri, Ortega, Felix, Pasupuleti, Kaw, and Hernandez. Acquisition of data: Jeon, Denegri, Ortega, Felix, and Pasupuleti. Analysis and interpretation of data: Jeon, Denegri, Ortega, Felix, and Hernandez. Drafting of the manuscript: Jeon, Denegri, Ortega, Felix, Kaw, and Hernandez. Critical revision of the manuscript for important intellectual content: Jeon, Pasupuleti, Kaw, and Hernandez. Statistical analysis: Denegri, Ortega, Felix, Jeon, and Hernandez. Administrative, technical, and material support: Pasupuleti, Kaw, and Hernandez. Study supervision: Kaw and Hernandez.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Adrian V. Hernandez.

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Appendix

Appendix

Fig. 6
figure 6

Forest plot of the association between adaptive servo-ventilation (ASV) and systolic blood pressure

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Fig. 7
figure 7

Forest plot of the association between adaptive servo-ventilation (ASV) and diastolic blood pressure

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Fig. 8
figure 8

Forest plot of the association between adaptive servo-ventilation (ASV) and LVESD in RCTs

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Fig. 9
figure 9

Forest plot of the association between adaptive servo-ventilation (ASV) and LVEDD in RCTs

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Hernandez, A.V., Jeon, A., Denegri-Galvan, J. et al. Use of adaptive servo ventilation therapy as treatment of sleep-disordered breathing and heart failure: a systematic review and meta-analysis. Sleep Breath 24, 49–63 (2020). https://doi.org/10.1007/s11325-019-01882-8

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