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• W2807661387 abstract "As seen in this CME online activity (available at http://journal.cme.chestnet.org/sv-sleep-disorder), central sleep apnea (CSA) is associated with increased mortality in patients with heart failure (HF), and it has been thought that treatment of CSA may improve underlying HF. Positive airway pressure therapy, specifically auto-servoventilation (ASV), can not only suppress abnormal breathing patterns but has been reported to improve cardiac function in HF patients with CSA. In patients with HF and with CSA unsuppressed with CPAP, newer ASV use has been associated with significant CSA improvement; in addition, several studies have reported efficacy of ASV in the treatment of underlying cardiac dysfunction in HF patients with CSA. However, results from the large randomized Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo-Ventilation in Patients with Heart Failure (SERVE-HF) trial (Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. New Engl J Med. 2015;373[12]:1095-1105) showed no significant effect on the primary end point in patients with stable HF with reduced ejection fraction and predominantly CSA, but all-cause and cardiovascular mortality were both increased in the ASV arm. These results are surprising and inconsistent with earlier smaller studies reporting positive surrogate outcomes, and they require additional study and resolution. However, until this is done, there is an urgent educational need for review of the approved labeling and validated clinical use of ASV within the medical community. The purpose of this educational activity is to review the appropriate use of ASV for the treatment of sleep-disordered breathing, including Cheyne-Stokes respiration, treatment-emergent central apnea, and opioid-induced periodic breathing. Emphasis will be placed on proper patient and therapy selection, especially in patients with HF. As seen in this CME online activity (available at http://journal.cme.chestnet.org/sv-sleep-disorder), central sleep apnea (CSA) is associated with increased mortality in patients with heart failure (HF), and it has been thought that treatment of CSA may improve underlying HF. Positive airway pressure therapy, specifically auto-servoventilation (ASV), can not only suppress abnormal breathing patterns but has been reported to improve cardiac function in HF patients with CSA. In patients with HF and with CSA unsuppressed with CPAP, newer ASV use has been associated with significant CSA improvement; in addition, several studies have reported efficacy of ASV in the treatment of underlying cardiac dysfunction in HF patients with CSA. However, results from the large randomized Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo-Ventilation in Patients with Heart Failure (SERVE-HF) trial (Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. New Engl J Med. 2015;373[12]:1095-1105) showed no significant effect on the primary end point in patients with stable HF with reduced ejection fraction and predominantly CSA, but all-cause and cardiovascular mortality were both increased in the ASV arm. These results are surprising and inconsistent with earlier smaller studies reporting positive surrogate outcomes, and they require additional study and resolution. However, until this is done, there is an urgent educational need for review of the approved labeling and validated clinical use of ASV within the medical community. The purpose of this educational activity is to review the appropriate use of ASV for the treatment of sleep-disordered breathing, including Cheyne-Stokes respiration, treatment-emergent central apnea, and opioid-induced periodic breathing. Emphasis will be placed on proper patient and therapy selection, especially in patients with HF. Editor’s Note: This is one in a series of Elsevier and CHEST sponsored activities with CME. The readers can view the video and claim CME. It is the policy of The Elsevier Office of Continuing Medical Education that all faculty, instructors, and planners disclose any real or apparent conflict of interest relating to topics of this educational activity. The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this continuing education activity: V. S. is a consultant for Ronda Grey, ResMed, U-Health, GlaxoSmithKline, Sorin Inc, Respironics, and Respicardia; and has received grants/research funding from Philips Respironics Foundation. M. A. has received grants/research funding and been on the speakers bureaus for ResMed and Philips Respironics. T. D. B. has received grants/research funding from the Canadian Institutes of Health Research and Philips Respironics. W. R. has received grants/research funding from Heinen + Löwenstein and Philips Respironics; and is on the speakers bureaus for Weinmann, Inspire, Philips Respironics, and ResMed. R. T. has received grant/research support from ResMed. Christine Won, MD, hereby states that neither she nor her spouse/life partner have any financial relationships to products or devices with any commercial interests related to the content of this activity of any amount in the prior 12 months to her participation. This activity is intended for health-care professionals involved in the management of patients with sleep-disordered breathing. This especially applies to the following clinical and research fields: sleep medicine, pulmonary care medicine, sleep technology, respiratory therapy, nursing and nurse practitioners, and physician assistants. On completion of this activity, participants will be better able to do the following (see Supplemental Material):•Review the relationship between OSA and cardiovascular diseases•Explain the mechanisms linking nocturnal hypoxemia and obstructive apneas to structural and functional cardiovascular changes•Describe the possible contribution of OSA to hypertension, atrial fibrillation, myocardial infarction, and sudden death See this CME Resource Center activity at http://journal.cme.chestnet.org/copd-hot-hmv for more information. This educational activity is jointly provided by the Elsevier Office of Continuing Education and Global Education Group. This activity has been supported by an educational grant from Philips Respironics. Download .pdf (.31 MB) Help with pdf files e-Online Data" @default.
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• W2807661387 date "2018-06-01" @default.
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• W2807661387 title "Servo-Ventilation Therapy for Sleep-Disordered Breathing" @default.
• W2807661387 doi "https://doi.org/10.1016/j.chest.2018.03.052" @default.
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