Background

This review is a short summary of the Cochrane Review entitled “Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure”.1 Heart failure (HF) is the most common cause of death worldwide, and its incidence is rapidly increasing. HF is characterised by symptoms such as fatigue and breathlessness during light activity as well as disordered breathing during sleep. In particular, sleep-disordered breathing (SDB), including central sleep apnoea (CSA) and obstructive sleep apnoea (OSA), is highly prevalent in individuals with chronic HF. Nakamura in his meta-analysis found that adaptive servo-ventilation (ASV) in PAP (positive airway pressure) therapy reduced all-cause mortality (risk ratio (RR) 0.13, 95% CI 0.02 to 0.95) among individuals with HF who had CSA, whereas continuous PAP (CPAP) was not associated with changes in mortality rate.2 However, a recent large trial—the Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients With Heart Failure (SERVE-HF)—found that ASV including PAP therapy had a higher risk of all-cause mortality and cardiovascular mortality. There was therefore the need for a meta-analysis that included recent trials. The European Society of Cardiology guidelines recommend PAP therapy to improve outcomes caused by SDB, especially OSA for individuals with HF.3 However, ASV in PAP therapy is not recommended for individuals who have HF with reduced ejection fraction (HFrEF) and CSA in light of the results of the SERVE-HF trial.3 4 However, the Study of the Effects of Adaptive Servo-ventilation Therapy on Cardiac Function and Remodeling in Patients with Chronic Heart Failure (SAVIOR-C) trial, which investigated the effects of ASV in HFrEF regardless of SDB in Japan, reported no significant differences in cardiovascular events between ASV and the control group.5 Furthermore, clinical composite response, New York Heart Association (NYHA) classification and symptoms during daily activities …