Yatsu Shoichiro, Woo Anna, Horvath Christian M, Tobushi Tomoyuki, Logan Alexander G, Floras John S, Tomlinson George, Bradley T Douglas
Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada.
Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
JACC Heart Fail. 2025 Apr 30:102434. doi: 10.1016/j.jchf.2025.02.016.
Sleep-disordered breathing (SDB), comprising obstructive sleep apnea (OSA) and central sleep apnea (CSA), could promote left ventricular (LV) remodeling and systolic dysfunction.
The authors tested the hypothesis, in the ADVENT-HF (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction) trial, that SDB is associated with reversible impairment of LV structure and function.
Participants underwent echocardiography (ejection fraction ≤45%) and polysomnography. They were classified as no-SDB (apnea-hypopnea index [AHI] <15/h); OSA (AHI ≥15/h with ≥50% of events obstructive), or CSA (AHI ≥15 with >50% of events central). Those with SDB were randomized to a control group or to peak-flow-triggered adaptive servo-ventilation (ASV) to treat SDB and, in them, echocardiography was repeated 6 months later.
Subjects with OSA (n = 543) had similar LV structure and function to those without SDB (n = 56). Subjects with CSA (n = 201) had greater LV mass index and lower LV ejection fraction than the other groups. LV volumes were higher in the CSA than in the OSA group (P < 0.05 for all). ASV abolished SDB, but had no significant effect, whether evaluated by allocation or adherence, 6 months post-randomization on LV structure or function for the entire cohort (n = 549), or either subgroup.
Among patients with heart failure with reduced ejection fraction, those with OSA had similar LV structure and function to those without SDB. Patients with CSA had greater LV remodeling and systolic dysfunction than those with OSA or without SDB. Six months of SDB suppression of OSA and CSA by ASV had no impact on LV structure or function. (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction [ADVENT-HF]).
睡眠呼吸障碍（SDB）包括阻塞性睡眠呼吸暂停（OSA）和中枢性睡眠呼吸暂停（CSA），可促进左心室（LV）重构和收缩功能障碍。
在ADVENT-HF（射血分数降低的心力衰竭患者睡眠呼吸障碍的适应性伺服通气）试验中，作者检验了SDB与LV结构和功能的可逆性损害相关的假设。
参与者接受了超声心动图检查（射血分数≤45%）和多导睡眠图检查。他们被分类为无SDB（呼吸暂停低通气指数[AHI]<15次/小时）；OSA（AHI≥15次/小时且≥50%的事件为阻塞性）或CSA（AHI≥15次/小时且>50%的事件为中枢性）。患有SDB的患者被随机分为对照组或峰值流量触发的适应性伺服通气（ASV）组以治疗SDB，6个月后对他们重复进行超声心动图检查。
患有OSA的受试者（n = 543）与无SDB的受试者（n = 56）的LV结构和功能相似。患有CSA的受试者（n = 201）比其他组具有更大的LV质量指数和更低的LV射血分数。CSA组的LV容积高于OSA组（所有比较P<0.05）。ASV消除了SDB，但在随机分组6个月后，无论是按分配还是依从性评估，对整个队列（n = 549）或任何一个亚组的LV结构或功能均无显著影响。
在射血分数降低的心力衰竭患者中，患有OSA的患者与无SDB的患者具有相似的LV结构和功能。患有CSA的患者比患有OSA或无SDB的患者具有更大的LV重构和收缩功能障碍。通过ASV对OSA和CSA进行6个月的SDB抑制对LV结构或功能没有影响。（射血分数降低的心力衰竭患者睡眠呼吸障碍的适应性伺服通气[ADVENT-HF]）
