心力衰竭合并睡眠呼吸暂停患者的适应性伺服通气治疗:ADVENT-HF研究的思考

Adaptive servo-ventilation in patients with heart failure and sleep apnea:Insights from the ADVENT-HF trial

心力衰竭与阻塞性睡眠呼吸暂停和中枢性睡眠呼吸暂停密切相关。2015年SERVE-HF研究表明,适应性伺服通气治疗中枢性睡眠呼吸暂停可导致左室射血分数降低的心力衰竭患者全因死亡率及心血管疾病死亡率增加。基于这些发现,美国睡眠医学会和欧洲心脏病学会在其治疗指南中推荐,对左心室射血分数≤45%的心力衰竭患者,不应使用适应性伺服通气治疗中枢性睡眠呼吸暂停。而近期另一项随机对照试验ADVENT-HF研究正式发布的结果显示,适应性伺服通气没有增加心血管不良结局且能改善患者的生活质量。我们针对这一结果进行了讨论。

Heart failure is strongly associated with obstructive and central sleep apnea.The landmark 2015 SERVE-HF trial showed that using adaptive servo-ventilation(ASV)for central sleep apnea(CSA)management was associated with an increased risk of all-cause and cardiovascular mortality among heart failure patients with reduced ejection fractions.Based on the result,the American Academy of Sleep Medicine and the European Society of Cardiology have recommended against the use of ASV for the treatment of CSA in patients with heart failure with an ejection fraction≤45%.Recently,the results from the ADVENT-HF trial have been formally published,indicating that ASV does not increase adverse outcomes and can improve patients′quality of life.Here,we go over these findings in detail.