Implications for clinical practice
Reduced LVEF should be excluded before using ASV9
SERVE-HF identified a specific at-risk patient population. The harmful effects of ASV correlate with pre-existing LV systolic impairment and the mortality risk is in patients with LVEF<45%. ASV therapy is contraindicated in patients with chronic, symptomatic heart failure with reduced left ventricular ejection fraction (LVEF≤45%) and moderate to severe predominant central sleep apnea. Reduced LVEF should be excluded before using ASV.9 It is therefore important to ensure that LVEF is >45% and echocardiography is recommended for this purpose.
Some patients – especially if referred by a cardiologist – may already have undergone echocardiography so it is worthwhile checking their medical notes. If not, a cardiology referral may be worth considering, as a high proportion of patients with SDB have some form of underlying cardiac disease.