Impact of sleep-disordered breathing and its treatment with ASV on left ventricular structure and function in heart failure

<bold>Introduction:</bold> Sleep-disordered breathing (SDB), comprising obstructive and central sleep apnea (OSA and CSA) could contribute to left ventricular (LV) remodeling and systolic dysfunction. This analysis of the ADVENT-HF trial tested the hypothesis that SDB is associated with reversible impairment of LV structure and function in patients with heart failure with reduced ejection fraction (LVEF<45%). <bold>Methods:</bold> Screening echocardiography and polysomnography were performed in patients with HF. Participants were classified into no-SDB (NSDB: apnea-hypopnea index [AHI] <15); OSA (AHI≥15 and ≥50% events obstructive) and CSA (AHI≥15 and >50% events central) and randomized to control or treatment with peak-flow triggered adaptive servo-ventilation (ASVPF) for SDB. Echocardiography was repeated 6 months later. <bold>Results:</bold> Subjects with OSA (n=543) had similar LV structure and function as those without SDB (n=56). Those with CSA (n=201) had greater LV mass index (106.6±25.4g/m2 for NSDB, 113.8±32.6 for OSA, and 126.6±38.5 for CSA, P<0.001) and lower LVEF than the other groups (35.0±10.6% for NSDB, 35.0±10.1 for OSA, and 31.0±10.2 for CSA, P<0.001). At follow-up (n=549), ASVPF had no effect on LV structure or function, aside from an increase in stroke volume index (SVI) (−0.7±11.3ml/m2 control; 1.2±10.3 ASVPF group, P=0.045). <bold>Conclusion:</bold> In this cohort, co-existing OSA appears not to exert adverse effects on LV structure or function. CSA signals more advanced LV remodeling and systolic dysfunction. ASVPF did not improve LV structure or function, aside from augmentation of SVI for the entire cohort.