Adaptive servo-ventilation and cardiovascular mortality in patients with central sleep apnea with heart failure: A meta-analysis and trial sequential analysis

Adaptive servo-ventilation (ASV) has been linked to cardiovascular (CV) mortality in patients with central sleep apnea (CSA) who also have heart failure with reduced left ventricular ejection fraction (LVEF). A meta-analysis and trial sequential analysis (TSA) of data from published randomized controlled trials (RCT) were conducted to synthesize the cumulative evidence of ASV on CV mortality in this patient population. Four RCTs met the inclusion criteria. Pooled odds ratio (OR) for CV mortality was 0.92 (95 % confidence intervals (CIs): 0.46 to 1.81, p = 0.80, I² = 54 %, suggesting that a firm conclusion on the effects of ASV on CV mortality is not possible. The last point of the Z-curve in TSA remained within the conventional test boundaries (the ‘not statistically significant zone’) and did not reach the required information size or futility boundaries. This further indicates that the finding of pooled OR on CV mortality is “inconclusive”, and that more RCTs are warranted to reach any firm conclusion.