01-21-2021, 04:27 PM
RE: Introduction
SleepriderIt depends. The risk cohort was defined as individuals with CHF and a left ventricular ejection fraction (LVEF%) of less than 45%, and that was a finding that led to abandonment of the SERVE-HF study. The problem was that study has serious design faults, used an older generation of ASV devices, used therapy settings no longer in common use, and used a cohort that was not titrated for efficacy or verified to have used the machines. https://pubmed.ncbi.nlm.nih.gov/26836904/
The mean AHI in the ASV group was 6.6 events per hour which tells you something about how poorly the machines were setup and monitored. The SERVE-HF trial results were widely interpreted as strong evidence that adaptive servo-ventilation was contraindicated for the treatment of central sleep apnea/Hunter-Cheyne-Stokes breathing in patients with heart failure and reduced ejection fraction. While the primary outcome of the trial was negative, the main reported finding of this was driven by analysis that was not part of the statistical original design of the trial and that could not be explained by any mechanistic analysis from the trial data.
Another study ADVENT-HF has been in progress since 2010 with the specific purpose of documenting any risk of ASV to the cohort of CHF patients with LVEF <45%. https://onlinelibrary.wiley.com/doi/full...2/ejhf.790 To date, that study has NOT identified an increased risk from ASV in this cohort, and has identified numerous benefits of treating the central apnea and Cheyne-Stokes Respiration. The study design is considerably different, and uses contemporary ASV devices and a carefully monitored study. https://www.advent-hf.com/
YOU: (I wish we could choose which parts to quote.)
So, the risk is hardly as well defined or a black and white issue, as your doctors are presenting to you,
ME:I have not spoken to my Drs about this so I would not have written that I had.
It was something I read in this thread, I think that made me ask both ResMed and Phillips and both advised against it for people with CHF.
COPD is another contra-indication.
LVEF is <40. The echo showed scarring from heart attack. I have not had one i said but she told me there is such a thing as a silent HA. Later my cardio told me it could have caused by an infection but didn't really elaborate on that. I am normally full of questions but all this happened whilst I was mentally disassociated from life and I didn't take any of it in. It has only been this last year that I have become aware of my situation and read my medical reports.
Having read your link, it would appear that the OSA going and the CSA still being there, but low, suggests there has been improvement with my heart.
I experience no symptoms of asthma, COPD or CHF and my HBP has been well controlled for many years, 20, and averages 118/64.
I can swim 1300-1500m in 45 mins. I do so 3-4 times a week when not in lockdown. We rae not likely to be out of lockdown till mid February. Because I am a wheelchair user-due to OA and DDD and brain damage which makes me fall without warning, I am unable to do any form of exercise other then swimming.
CSA can be caused by morphine I am told.
I still need to lose at lest 30lbs and am slowly still losing but it is harder and slower with no exercise.
and many CHF patients do benefit from the therapy when central apnea or cheyen-stokes respiration is present. Clearly, some of these individuals suffer greatly when the central AHI is very high. Furthermore, I have queried you about your LVEF in several posts through this thread, and while you did not offer a quantitative response, your description of your current condition and stage of disease, leads me to conclude it is unlikely that you actually match the profile of the "at-risk" cohort with LVEF <45%. The "advisory" against ASV does not extend to CHF in general, but to a specific group of systolic heart failure patients.
The mean AHI in the ASV group was 6.6 events per hour which tells you something about how poorly the machines were setup and monitored. The SERVE-HF trial results were widely interpreted as strong evidence that adaptive servo-ventilation was contraindicated for the treatment of central sleep apnea/Hunter-Cheyne-Stokes breathing in patients with heart failure and reduced ejection fraction. While the primary outcome of the trial was negative, the main reported finding of this was driven by analysis that was not part of the statistical original design of the trial and that could not be explained by any mechanistic analysis from the trial data.
Another study ADVENT-HF has been in progress since 2010 with the specific purpose of documenting any risk of ASV to the cohort of CHF patients with LVEF <45%. https://onlinelibrary.wiley.com/doi/full...2/ejhf.790 To date, that study has NOT identified an increased risk from ASV in this cohort, and has identified numerous benefits of treating the central apnea and Cheyne-Stokes Respiration. The study design is considerably different, and uses contemporary ASV devices and a carefully monitored study. https://www.advent-hf.com/
YOU: (I wish we could choose which parts to quote.)
So, the risk is hardly as well defined or a black and white issue, as your doctors are presenting to you,
ME:I have not spoken to my Drs about this so I would not have written that I had.
It was something I read in this thread, I think that made me ask both ResMed and Phillips and both advised against it for people with CHF.
COPD is another contra-indication.
LVEF is <40. The echo showed scarring from heart attack. I have not had one i said but she told me there is such a thing as a silent HA. Later my cardio told me it could have caused by an infection but didn't really elaborate on that. I am normally full of questions but all this happened whilst I was mentally disassociated from life and I didn't take any of it in. It has only been this last year that I have become aware of my situation and read my medical reports.
Having read your link, it would appear that the OSA going and the CSA still being there, but low, suggests there has been improvement with my heart.
I experience no symptoms of asthma, COPD or CHF and my HBP has been well controlled for many years, 20, and averages 118/64.
I can swim 1300-1500m in 45 mins. I do so 3-4 times a week when not in lockdown. We rae not likely to be out of lockdown till mid February. Because I am a wheelchair user-due to OA and DDD and brain damage which makes me fall without warning, I am unable to do any form of exercise other then swimming.
CSA can be caused by morphine I am told.
I still need to lose at lest 30lbs and am slowly still losing but it is harder and slower with no exercise.
and many CHF patients do benefit from the therapy when central apnea or cheyen-stokes respiration is present. Clearly, some of these individuals suffer greatly when the central AHI is very high. Furthermore, I have queried you about your LVEF in several posts through this thread, and while you did not offer a quantitative response, your description of your current condition and stage of disease, leads me to conclude it is unlikely that you actually match the profile of the "at-risk" cohort with LVEF <45%. The "advisory" against ASV does not extend to CHF in general, but to a specific group of systolic heart failure patients.
