What is the weight of evidence regarding the use of adaptive servo-ventilation for central sleep apnea in HFrEF?
The weight of evidence does not support the use of adaptive servo-ventilation for central sleep apnea in HFrEF. Data from multiple trials demonstrate a signal of harm when adaptive servo-ventilation is used for central sleep apnea. Mortality rate (all cause and cardiovascular) was higher with adaptive servo-ventilation plus GDMT than with GDMT alone in a single RCT to test the addition of adaptive servo-ventilation ( 5 hours/night, 7 days/week) to GDMT in patients with HFrEF and central sleep apnea.203 A similar risk has been seen in another trial, and a third trial of adaptive servo-ventilation in central sleep apnea and HF was aborted because of ethical concerns.