Central apnoeas, sympathetic activation and mortality in heart failure: look before you leap. Issue 3 (9th March 2023) - Borrelli, Chiara
In the recently published work by Tamisier et al. [1], the effect of adaptive servo-ventilation (ASV) on muscle sympathetic nerve activity (MSNA) was evaluated in a small subset of patients from the previously published cohort of the SERVE-HF trial [2]. The primary outcome for this analysis (on which power calculation was based) was the change in MSNA at 3 months follow-up in the two study arms (ASV plus guideline-based medical treatment, n=19, versus guideline-based medical treatment only, n=21). An additional explorative analysis about the impact on mortality of MSNA changes in time was also run by the authors. No significant differences from baseline were found at 3 months, either with respect to burst frequency or burst incidence between the two study arms. The authors also reported a negative impact of the decrease in MSNA burst incidence at 3 months in patients treated with ASV, compared to controls in whom this decrease seemed beneficial. The debate of central apnoea and its treatment in heart failure is very much alive, and measures comprising the effects on sympathetic measures of therapeutic options should be evaluated, albeit with careful consideration https://bit.ly/3EVpXKv