Abstract

Background: Central sleep apnoea/Cheyne Stokes Respiration (CSA/CSR) in heart failure is associated with an impaired prognosis. Continuous positive airway pressure (CPAP) and adaptive servo-ventilation (ASV) as well as nocturnal oxygen (O2) are treatment modalities for CSA/CSR. Whether treatment of CSA/CSR is beneficial is controversial.

Aims: Assess the effect of treatment of CSA/CSR on cardiac function in heart failure.

Methods: Databases were searched up to Dec 2017 for randomised controlled trials (RCTs) comparing the effect of any combination of CPAP, ASV, O2 or an inactive control on left ventricular ejection fraction (LVEF) in patients with heart failure and CSA/CSR. A network meta-analysis (multivariate random-effects meta-regression) was performed.

Results: 16 RCTs (951 patients; apnoea-hypopnoea-index 38±3/h, LVEF 29±3%) were included. Compared to inactive control, both CPAP and ASV significantly improved LVEF by 4.4% (95%CI 0.3-8.5%, p=0.036) and 3.8% (95%CI 0.6-7.0%, p=0.025), respectively, whereas O2 had no effect on LVEF (p=0.35). There was no difference between CPAP and ASV (p=0.76). The treatment effect of positive pressure ventilation was larger when baseline LVEF was lower in systolic heart failure.

Conclusions: CPAP and ASV are effective in improving LVEF in patients with heart failure and CSA/CSR, whereas O2 is not. There is no difference in the effect on LVEF between CPAP and ASV.