BACKGROUND: Adaptive servo-ventilation (ASV) has demonstrated efficacy in treating sleep-disordered breathing (SDB) in patients with heart failure (HF), but large randomized trials are lacking. We therefore sought to perform a systematic review and meta-analysis of existing data. METHODS: A systematic search of the PubMed database was undertaken in March 2012; publications were independently assessed by two investigators in order to identify studies of >= 1 week duration comparing ASV to a control condition (sub-therapeutic ASV, continuous or bi-level positive airway pressure, oxygen therapy, or no treatment) in adult patients with SDB and HF. Mean, variability and sample size data were extracted independently for the following outcomes: apnea-hypopnea index (AHI), left ventricular ejection fraction (LVEF), quality of life (SF-36 Health Survey), 6-minute walk distance, peak VO2 percent predicted and VE/VCO2 slope measured during exercise. Random effects meta-analysis models were applied. RESULTS: Fourteen studies were identified (n = 538). Comparing ASV to control conditions, the weighted mean difference in AHI (-14.64 events/hour, 95% CI -21.03 to -8.25) and LVEF (0.40, 95% CI 0.08 to 0.71) both significantly favored ASV. ASV also improved the 6-minute walk distance, but not peak VO2 percent predicted, VE/VCO2 slope, or quality of life, compared to control conditions. CONCLUSIONS: In patients with HF and SDB, ASV is more efficacious than control conditions in reducing the AHI and improving cardiac function and exercise capacity. These data provide a compelling rationale for large-scale randomized controlled trials to assess the clinical impact of ASV on hard outcomes in these patients.

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