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SERVE-HF and Central Sleep Apnoea — EECC MCQ

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HardHeart FailureSERVE-HF and Central Sleep ApnoeaEECC

A 55-year-old man with HFrEF (LVEF 25%) develops Cheyne-Stokes respiration and central sleep apnoea confirmed on polysomnography. The SERVE-HF trial results are discussed. What did this trial demonstrate regarding adaptive servo-ventilation (ASV)?

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Correct answer: B — ASV increased cardiovascular mortality in HFrEF patients with central sleep apnoea and is therefore contraindicated in this population

The SERVE-HF trial (2015) was a landmark negative trial that demonstrated ASV (adaptive servo-ventilation) increased all-cause and cardiovascular mortality in patients with HFrEF (LVEF ≤45%) and predominantly central sleep apnoea (CSA). This unexpected finding led to a contraindication for ASV in HFrEF with CSA. The mechanism is thought to involve excessive suppression of sympathetic activation (which may be compensatory in severe HF) and haemodynamic effects of positive pressure ventilation. CSA in HF (Cheyne-Stokes respiration) is primarily a consequence of HF severity rather than a modifiable therapeutic target. Treatment should focus on optimising HF therapy. CPAP remains appropriate for obstructive sleep apnoea.

Reference: ESC (2023): HF Guidelines; SERVE-HF Trial