Effects of adaptive servoventilation on sleep quality in treatment emergent and central sleep apnea in heart failure patients with preserved ejection fraction

Background:

Reduced sleep quality is associated with increased mortality in patients with heart failure. This study compares the effects of ASV therapy on sleep quality, sleep fragmentation and excessive daytime sleepiness in heart failure patients with preserved ejection fraction (HFpEF) treated with ASV for central sleep apnea (CSA) or treatment emergent central sleep apnea (TECSA).

Methods:

This retrospective study enrolled 114 patients with HFpEF introduced to ASV therapy between March 2010 and October 2015. The patients were stratified into two groups with TECSA (n = 60) or CSA (n = 54) at the diagnostic polysomnography (PSG). Changes of sleep quality and sleep fragmentation from baseline to ASV initiation were compared. Effects on daytime sleepiness were assessed 27 months after ASV initiation.

Results:

In the first night of ASV therapy patients with TECSA and CSA showed a similar and significant reduction in apnea-hypopnea index (AHI) and arousal index (ΔAHI: -43 ± 21 vs. -47 ± 22/h, p = 0.333; Δarousal index -11 ± 15, vs. -12 ± 21/h, p = 0.916). Both groups also presented a significantly longer N3 and REM sleep while REM sleep increased significantly in TECSA compared to CSA (ΔN3: 8 ± 11 vs. 8 ± 13%, p = 0.795; ΔREM 6 ± 9 vs. 3 ± 8%, p = 0.048). ASV treatment lead to a significant increase in sleep efficiency in TECSA compared to CSA in HFpEF patients (10 ± 19% vs. 1 ± 18%, p = 0.019). Both groups showed a similar and significant reduction in subjective daytime sleepiness 27 months after therapy initiation (ESS: -3 ± 4 vs. -3 ± 4, p = 0.795).

Conclusions:

ASV therapy improves sleep quality, sleep fragmentation and daytime sleepiness in HFpEF patients with TECSA and CSA. Only in TECSA patients, ASV therapy was associated with an increase in sleep efficiency.