Sleep disordered breathing (SDB) is considered a risk factor for cardiovascular disease (CVD). Obstructive sleep apnoea (OSA) can be treated with continuous positive airway pressure (CPAP), and central sleep apnoea (CSA), in patients with heart failure with reduced ejection fraction (HFrEF), by peak flow-triggered adaptive servo-ventilation. Presently, there is equipoise as to whether treating SDB prevents cardiovascular events. Some propose treatment for this indication, based on observational data, while others argue against because of the lack of randomised trial evidence. This review evaluates literature concerning the cardiovascular effects of treating SDB with PAP devices in individuals with and without CVDs. Nine observational studies report significantly lower cardiovascular event rates in those treated, than in those not treated, for SDB. Conversely, 12 randomised trials in which excessive daytime sleepiness was generally an exclusion criterion showed no reduction in cardiovascular event rates. The SERVE-HF trial showed an increase in mortality with use of minute ventilation-triggered adaptive servo-ventilation for CSA in patients with HFrEF. In the ADVENT-HF trial, treating HFrEF patients with coexisting OSA or CSA using peak flow-triggered adaptive servo-ventilation was safe and improved sleep structure and heart failure-related quality of life but did not reduce all-cause mortality or cardiovascular events. More evidence is required to determine whether treating CSA in patients with HFrEF prevents cardiovascular events and improves survival. Presently, the rationale for treating SDB with PAP remains improving sleep structure and quality of life, as well as relieving excessive daytime sleepiness, but not reducing cardiovascular events.

中文翻译：

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治疗睡眠呼吸障碍对心血管结局的影响：观察性和随机试验证据。


睡眠呼吸障碍 （SDB） 被认为是心血管疾病 （CVD） 的危险因素。阻塞性睡眠呼吸暂停 （OSA） 可采用持续气道正压通气 （CPAP） 和中枢性睡眠呼吸暂停 （CSA） 治疗，对于射血分数降低的心力衰竭 （HFrEF） 患者，可通过峰值流量触发的适应性伺服通气进行治疗。目前，治疗 SDB 是否能预防心血管事件存在平衡。一些人根据观察数据建议治疗这一适应症，而另一些人则因为缺乏随机试验证据而反对。本综述评估了有关使用 PAP 装置治疗 SDB 对 CVD 患者和非 CVD 个体的心血管影响的文献。9 项观察性研究报告称，接受 SDB 治疗的患者的心血管事件发生率显著低于未接受治疗的患者。相反，12 项随机试验通常将白天过度嗜睡作为排除标准，结果显示心血管事件发生率没有降低。SERVE-HF 试验显示，在 HFrEF 患者中，使用分钟通气触发的适应性伺服通气治疗 CSA 的死亡率增加。在 ADVENT-HF 试验中，使用峰值流量触发的适应性伺服通气治疗共存 OSA 或 CSA 的 HFrEF 患者是安全的，并改善了睡眠结构和心力衰竭相关的生活质量，但并未降低全因死亡率或心血管事件。需要更多的证据来确定治疗 HFrEF 患者的 CSA 是否能预防心血管事件并提高生存率。目前，用 PAP 治疗 SDB 的基本原理仍然是改善睡眠结构和生活质量，以及缓解白天过度嗜睡，但不能减少心血管事件。