Abstract 12622: Long Term Use of Adaptive Servo Ventilation Improves and Maintains Cardiac Function in Patients With Heart Failure With Central Sleep Apnea and Prevents Readmission Due to Worsening Heart Failure Compared to Short Term Use

Introduction: Central sleep apnea (CSA) is closely associated with poor prognosis in heart failure (HF) patients. Adaptive servo-ventilation (ASV) was expected as a new treatment for HF patients with CSA. However, the efficacy of ASV is controversial, especially the efficacy of long-term use has remained unclear.

Methods: We retrospectively examined all HF patients with CSA treated with ASV seen between May 2008 and November 2022 in our hospital who had not been admitted to the hospital due to worsening HF in the 6 months before initiating ASV therapy. We divided them into 2 groups: (A) non-continues-ASV-treated patients; (B) continues-ASV-treated patients. The outcome was a composite of readmission due to worsening HF and all-cause mortality.

Results: During a median follow-up of 10.3 years after leaving the hospital, 11 patients died out of 101 patients. Twenty-two patients (group A) could not continue to use ASV because of its discomfort. Seventy-nine patients (group B) could continue to use the ASV device at night after leaving the hospital over a long period. There were almost no significant differences in the baseline characteristics between the two groups. In group B, during 6-, 12-, and 24-month observations, left ventricular ejection fraction (46.4 +/- 17.9 to 47.1 +/- 15.6, 49.8 +/- 15.8, and 48.2+/- 18.9%, p<0.05 compared with baseline) and brain natriuretic peptide (685.5 +/- 1087.2 to 233.1+/- 362.9, 391.8 +/- 929.0 and 166.9 +/- 195.1 pg/ml, p<0.05 compared with baseline) improved significantly. And there was significantly less readmission by worsening HF than in group A (log-rank P<0.001). However, there were no significant differences in all-cause mortality between the two groups (log-rank P=0.221).

Conclusions: This study showed that long-term ASV therapy for more than 10 years reduced readmission by worsening HF with CSA patients compared to short-term use due to improved and maintained cardiac function but did not affect mortality.