Hospital Pedro Hispano, Porto, Portugal.
Centro Hospitalar de Setubal, Portugal.
Pulmonology. 2023 Mar-Apr;29(2):138-143. doi: 10.1016/j.pulmoe.2021.12.002. Epub 2022 Apr 29.
It is known that patients with heart failure (HF) have an increased risk of developing central sleep apnoea (CSA), with Cheyne-Stokes respiration. The development of servo-ventilation aimed to treat CSA and improve the quality of life (QoL) of these patients. A large randomized clinical study, SERVE-HF, was conducted in order to test this theory in patients with HF and reduced ejection fraction (HFrEF). The results from this trial seemed to indicate that, in these patients, there was no beneficial effect of the assisted ventilation in CSA treatment. More surprisingly, an increased rate of all-cause or cardiovascular mortality was observed. This has led to dramatic changes in clinical practice, with decreased frequency of servo-ventilation prescription across Europe, including Portugal, due to changes in the guidelines. However, SERVE-HF was conducted only in severe systolic HF patients with CSA, and caution must be taken when extrapolating these results to HF patients with preserved ejection fraction or CSA patients without HF. The study also showed poor adherence, methodological and statistical gaps, including study design, patient selection, data collection and analysis, treatment adherence, and group crossovers, which have not been discussed in the trial as potential confounding factors and raise several concerns. Moreover, the adaptive servo-ventilation (ASV) device used in SERVE-HF was unable to lower the minimum support pressure below 3 mm H0, and this has been suggested as one of the probable contributing reasons to the excess mortality observed in this study. This limitation has since been solved, and this ASV device is no longer used. This paper describes the results of a Portuguese Task Force on the treatment of central sleep apnoea in patients with chronic HF.
已知心力衰竭（HF）患者发生中枢性睡眠呼吸暂停（CSA）伴 Cheyne-Stokes 呼吸的风险增加。伺服通气的发展旨在治疗 CSA 并改善这些患者的生活质量（QoL）。一项大型随机临床试验 SERVE-HF 旨在检验 HF 和射血分数降低（HFrEF）患者中这一理论。该试验结果似乎表明，在这些患者中，辅助通气对 CSA 治疗没有有益效果。更令人惊讶的是，观察到全因或心血管死亡率增加。这导致了临床实践的重大变化，由于指南的改变，欧洲包括葡萄牙在内的伺服通气处方频率降低。然而，SERVE-HF 仅在伴有 CSA 的严重收缩性 HF 患者中进行，当将这些结果外推至射血分数保留的 HF 患者或无 HF 的 CSA 患者时，必须谨慎。该研究还显示出较差的依从性、方法学和统计学差距，包括研究设计、患者选择、数据收集和分析、治疗依从性以及组交叉，这些在试验中并未被讨论为潜在混杂因素，并引起了一些关注。此外，SERVE-HF 中使用的适应性伺服通气（ASV）装置无法将最低支持压力降低到 3 毫米水柱以下，这被认为是该研究中观察到的超额死亡率的一个可能原因。这个限制已经得到解决，并且不再使用这种 ASV 装置。本文描述了葡萄牙慢性心力衰竭患者中枢性睡眠呼吸暂停治疗专题小组的研究结果。
