Effects of adaptive servo‐ventilation in patients with heart failure with reduced ejection fraction and sleep apnea on periodic leg movements, sleepiness and fatigue—An ancillary analysis of a multicenter randomized controlled trial

Abstract Background Emergence of periodic leg movements (PLM) on adaptive servo‐ventilation (ASV) is well known in patients with chronic heart failure and reduced ejection fraction (HFrEF), but its clinical significance remains unclear. We investigated the effect of ASV on the emergence of PLM with arousal (PLMA) in HFrEF patients with obstructive or central sleep apnea (OSA or CSA) and determined whether emergent PLMA modifies the effect of ASV on fatigue and sleepiness. Methods Sixty stable HFrEF patients (ASV n = 29, control n = 31) with moderate to severe OSA or CSA were included. Polysomnography (PSG) was obtained at baseline and after 12 weeks. Results In HFrEF patients with OSA and CSA, ASV significantly increased PLMA‐Index compared to control. ASV was associated with a significant reduction in Epworth sleepiness scale (ESS) and fatigue severity scale (FSS) in patients without emergent PLMA (52%) compared to those with emergent PLMA (48%; delta ESS: −3 (−3; 0) vs. 2 (−2; 4) p = 0.027; delta FSS: −1.3 (−2.1; 0.1) vs. −0.3 (−1.1; 1.7) p = 0.031) and compared to controls (0 (−1; 1) p = 0.039); (0.1 (−0.9; 0.4) p = 0.034). Conclusion ASV treatment increases PLMA in some HFrEF patients with OSA or CSA. On ASV treatment, patients reported only improved sleepiness and fatigue if no PLMA emerged.