The use of adaptive servo-ventilation to treat central sleep apnoea in patients with systolic heart failure increases mortality, an international trial finds.

The randomised SERVE-HF phase III study of 1325 patients with symptomatic chronic heart failure, reduced ejection fraction and central sleep apnoea found that adding adaptive servo-ventilation (ASV) to guideline-based medical treatment did not improve patient outcomes.

Furthermore after a median of 31 months follow-up the risk of cardiovascular death in patient randomised to ASV increased by 34% (29·9% vs 24·0%, hazard ratio [HR] 1·34, 95% CI 1·09–1·65; p=0·006).

“The early and sustained increase in cardiovascular mortality seen in the adaptive servo-ventilation group in this trial was unexpected, and the pathophysiological features of this effect remain to be elucidated,” wrote the authors of the study published in the NEJM. 

 Positive airway pressure (PAP) therapy (not particularly adaptive servo-ventilation) might lead to adverse consequences on cardiac function in some patients; or some aspects of Cheyne–Stokes respiration may be beneficial, they suggested.

An accompanying editorial to the study advised that: “Until other studies clarify whether the results seen in the SERVE-HF trial are a consequence of the specific device that was used, we recommend that adaptive servo-ventilation not be used outside clinical trials in patients with heart failure who have predominantly central sleep apnea”.