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A research team led by scientists at UHN has found that in patients with heart failure, treatment of co-existing obstructive or central sleep apnea with a non-invasive breathing device called adaptive servo-ventilation (ASV), improved their quality of life.
Patients living with heart failure and obstructive or central sleep apnea suffer from poor sleep, daytime fatigue and excessive sleepiness, shortness of breath and premature death.
The research team, led by Dr. Douglas Bradley, a Senior Scientist at UHN's KITE Research Institute, found that patients in the group treated with ASV in a trial called ADVENT-HF were less short of breath, less sleepy, and reported better quality of life than those in the untreated group.
Dr. Bradley is Director of the Sleep Research Laboratory at KITE and the Centre for Sleep Medicine and Research at Toronto General Hospital.
Dr. Bradley notes that improving quality of life is a major objective in heart failure research and this research helps to advance that goal. He added that the findings, which were published in
Lancet Respiratory Medicine, should help cardiologists worldwide update their heart failure treatment guidelines.
Dr. Bradley discussed the significance of these findings.
Q: Which patient groups are most affected by this?
(Dr. Bradley) Patients who have heart failure and co-existing obstructive or central sleep apnea. Such individuals suffer from poor sleep, daytime fatigue, shortness of breath, and premature death. The ADVENT-HF trial enrolled 731 such individuals.
Q: What did you find?
Half of participants were assigned to no treatment for sleep apnea and half to treatment with a device, adaptive servo-ventilation, that alleviates sleep apnea. Treated patients lived no longer than untreated patients, but were less short of breath, less sleepy and reported better quality of life. In those with central sleep apnea, treatment tended to improve survival, unlike an older type of adaptive servo-ventilation that reduced survival.
Q: Why does this matter?
ADVENT-HF is the first trial to address whether treating obstructive sleep apnea in heart failure prolongs life – it does not. However, although contemporary treatment of heart failure has lowered death rates, it has increased the number of patients living with heart failure and its debilitating symptoms. Thus, improving quality of life is a major objective in heart failure research. Our novel demonstration that treating co-existing sleep apnea with adaptive servo-ventilation in heart failure improves quality of life, advances this goal.
Q: What is the potential impact?
Current heart failure management guidelines do not include treating sleep apnea because evidence is lacking that it provides benefit. They also recommend against treating central sleep apnea with adaptive servo-ventilation based on an increased death rate in another trial. By showing that treatment of obstructive and central sleep apnea is safe and improves quality of life, our findings will help cardiologists worldwide update their heart failure treatment guidelines.