LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing

BACKGROUND: Sleep-disordered breathing (SDB), comprising obstructive sleep apnea (OSA) and central sleep apnea (CSA), could promote left ventricular (LV) remodeling and systolic dysfunction. OBJECTIVES: The authors tested the hypothesis, in the ADVENT-HF (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction) trial, that SDB is associated with reversible impairment of LV structure and function. METHODS: Participants underwent echocardiography (ejection fraction ≤45%) and polysomnography. They were classified as no-SDB (apnea-hypopnea index [AHI] <15/h); OSA (AHI ≥15/h with ≥50% of events obstructive), or CSA (AHI ≥15 with >50% of events central). Those with SDB were randomized to a control group or to peak-flow-triggered adaptive servo-ventilation (ASV_PF) to treat SDB and, in them, echocardiography was repeated 6 months later. RESULTS: Subjects with OSA (n = 543) had similar LV structure and function to those without SDB (n = 56). Subjects with CSA (n = 201) had greater LV mass index and lower LV ejection fraction than the other groups. LV volumes were higher in the CSA than in the OSA group (P < 0.05 for all). ASV_PF abolished SDB, but had no significant effect, whether evaluated by allocation or adherence, 6 months post-randomization on LV structure or function for the entire cohort (n = 549), or either subgroup. CONCLUSIONS: Among patients with heart failure with reduced ejection fraction, those with OSA had similar LV structure and function to those without SDB. Patients with CSA had greater LV remodeling and systolic dysfunction than those with OSA or without SDB. Six months of SDB suppression of OSA and CSA by ASV_PF had no impact on LV structure or function. (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction [ADVENT-HF]).