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New England Journal of Medicine Editorial on SERVE-HF

September 17, 2015

Central sleep apnea occurring within the cyclic breathing pattern of Cheyne–Stokes respiration has been reported to be common in patients with heart failure.1 During sleep, episodes of hyperventilation followed by a complete cessation (apnea) or decrease (hypopnea) in breathing are associated with oxyhemoglobin desaturations, arousals, and sympathetic nervous system activation that could be deleterious to the failing heart. Thus, suppression of central sleep apneas and hypopneas seemed to be a reasonable target in the treatment of patients with heart failure.

Cowie et al.2 now describe in the Journal the results of the SERVE-HF (Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) trial, which investigated the effects of adding adaptive servo-ventilation to guideline-based medical treatment on survival and cardiovascular outcomes in patients with a left ventricular ejection fraction of 45% or less and predominantly central sleep apnea. Adaptive servo-ventilation unexpectedly resulted in increased cardiovascular mortality.

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