Researchers have found that sleep apnoea patients with heart failure who use adaptive servo ventilation (ASV) may be at a greater risk of increased cardiovascular mortality compared to patients who are not treated using ASV.

The new study, published in the European Respiratory Journal, describes the results of an on-treatment analysis of the 2015 ‘Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients with Heart Failure’ (SERVE-HF) trial.

ASV has been shown to be the most effective form of positive airway pressure therapy for alleviating central sleep apnoea (CSA).

Researchers conducted an open-label, randomised control trial (RCT) in which 1,325 patients were assigned to either a control group who did not receive ASV treatment versus a patient group who did receive ASV treatment.

The results showed that ASV increased cardiovascular-related mortality in heart failure patients with central sleep apnoea, with the authors noting that selection bias may be a contributing factor that explains why observational data were more favourable for ASV than data from the SERVE-HF randomised clinical trial.

Another important outcome included the lack of a clear dose–response effect for ASV use and cardiovascular mortality; patients who used ASV for longer each night were not more likely to experience cardiovascular death than those with lower usage levels.

The new study is accompanied by an editorial by Dr. Douglas Bradley, ‘SERVE-HF on-treatment analysis: does the on-treatment analysis SERVE its purpose?’, also published in the European Respiratory Journal.