Abstract Background Many individuals with primary central sleep apnea (CSA) or treatment emergent central sleep apnea (TE-CSA) have an indication for adaptive servo ventilation (ASV) therapy. After the release of Serve-HF results in 2015, ASV therapy was interrupted and not initiated in patients with left ventricular ejection fraction (LVEF) below 45%. RESEARCH QUESTION: Are the effects of ASV therapy on all-cause mortality in patients indicated for ASV impacted by the eviction of patients with LEVF45%. Study Design and Methods Prospective observational cohort study conducted by a single healthcare provider and enrolled participants from November 2014 through November 2023. All patients were adults with predominant CSA at diagnosis or OSA with central events not controlled with CPAP were eligible. Baseline variables collected at ASV initiation were age, sexe, BMI, tobacco consumption, previous CPAP usage. At follow-up, ASV usage was averaged per year and status at the time point (ASV usage, association of oxygen, switch for different pressure device or termination. Death status was monitored by the healthcare provider if patients were still using ASV at the time point (end November 2024) or using French death registry in all patients who had terminated ASV therapy before the time point. Participants were divided into ASV initiation before (n = 246) or after (n = 731) LEVF45% contra-indication. A Mann and Whitney and Chi2 tests were used to compare the quantitative and qualitative variables between patients with/without withdrawal. Survival analysis for all causes of mortality to other factors was performed using the Kaplan Meier estimator followed by a Cox model. Univariate analysis with Cox model helps in identifying the key adjusted variables to perform the multivariate analysis. Results We included 977 individuals in the analysis. These were 88.1% male with a median Q1;Q3 age of 71.6 61.6;78.9 years, a BMI of 28.1 25.4;31.1 and with active and inactive tobacco consumption of 14.5 and 85.5%, respectively. The indication for ASV was post CPAP failure in 54.6% of patients. Mean duration of usage while patients were on ASV was 5.8 3.7;7.4. During follow-up period death occurred in 209 (21.4%) patients. In multivariate analysis there was an increased risk of death associated with the usage of ASV before LEVF45% contra-indication 0.574 0.365;0.904 p = 0.017 and not after, 0.756 0.468;1.222 p = 0.25.INTERPRETATION: In this study, individuals with a clinical indication for ASV therapy experienced an increased risk of death when using ASV before but not after LEVF45% contra-indication. This abstract is funded by: ANR-15-IDEX-02
Tamisier et al. (2026) studied this question.