Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.
Adv Exp Med Biol. 2022;1384:79-103. doi: 10.1007/978-3-031-06413-5_6.
The SERVE-HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) multicenter trial found a small but significant increase in all-cause and cardiovascular mortality in patients assigned to adaptive servo-ventilation (ASV) versus guideline-based medical treatment. To better understand the physiological underpinnings of this clinical outcome, we employ an integrative computer model to simulate congestive heart failure with Cheyne-Stokes respiration (CHF-CSR) in subjects with a broad spectrum of underlying pathogenetic mechanisms, as well as to determine the in silico changes in cardiopulmonary and autonomic physiology resulting from ASV. Our simulation results demonstrate that while the elimination of CSR through ASV can partially restore cardiorespiratory and autonomic physiology toward normality in the vast majority of CHF phenotypes, the degree of restoration can be highly variable, depending on the combination of CHF mechanisms in play. The group with the lowest left ventricular ejection fraction (LVEF) appears to be most vulnerable to the potentially adverse effects of ASV, but the level of pulmonary capillary wedge pressure (PCWP) plays an important role in determining the nature of these effects.
SERVE-HF（心力衰竭患者通过自适应伺服通气治疗主要中枢性睡眠呼吸暂停的治疗）多中心试验发现，与基于指南的药物治疗相比，接受自适应伺服通气（ASV）治疗的患者全因和心血管死亡率略有增加。为了更好地理解这一临床结果的生理基础，我们采用综合计算机模型来模拟充血性心力衰竭伴 Cheyne-Stokes 呼吸（CHF-CSR），其中包括广泛的潜在发病机制，并确定 ASV 引起的心肺和自主生理的计算机模拟变化。我们的模拟结果表明，虽然通过 ASV 消除 CSR 可以使大多数 CHF 表型的心肺和自主生理部分恢复正常，但恢复程度可能差异很大，具体取决于所涉及的 CHF 机制的组合。左心室射血分数（LVEF）最低的组似乎最容易受到 ASV 的潜在不良影响，但肺毛细血管楔压（PCWP）水平在确定这些影响的性质方面起着重要作用。
