Received some unsettling news from my DME regarding ASV.

I went to my DME last night to exchange my machine as it was starting to make a loud noise.

Before she swapped the units, she said "Do you have any heart problems? If you do, I have to take your machine and can't let you leave with one. A new study came out a bit ago and people with heart problems have a higher mortality when using ASV compared to people who don't use ASV." She then showed me a sheet that came with my replacement ASV with the study results on it.

I told her that I don't know if I have heart problems or not. I had some tests done which came back negative, but the doctors can't piece together what's causing my central apnea considering I am otherwise healthy.

Now I am a bit concerned that if I do have an undetected heart issue, that the ASV might be doing more harm than good. Since starting ASV 2 years ago, my heart palpitations have probably gotten worse, although aside from that I feel about the same.

Did anyone else see this news? What are we to make of it?

Hi -

I looked up the study, and I think your DME is being overly cautious. What the study actually found was a slightly elevated risk for patients with both predominantly central sleep apnea AND symptomatic chronic heart failure (meaning they've had ongoing cardiac issues, not sudden onset) with a reduced ejection fraction (which means the amount of blood your heart pumps out).

Seems like a pretty specific set of circumstances, but as always, if you're concerned you should discuss it with your doctor.

only with ASV therapy in patients with moderate to severe predominant central sleep apnea and symptomatic chronic heart failure with reduced ejection fraction.
http://www.resmed.com/us/en/consumer/ne ... erapy.html

my heart palpitations have probably gotten worse

What are you describing as heart palpitations?

icipher wrote:I don't know if I have heart problems or not. I had some tests done which came back negative

What tests did you have done, and what type doctors performed these tests?

It potentially affects people with congestive heart failure with ejection rates less than 45 I think it was.
Discussed earlier this summer I think it was on the forum.
Have you ever had a cardiac echocardiagram?
My understanding is the risk is increased with people who already have damaged hearts but that it doesn't cause the damage.

ChicagoGranny wrote:

only with ASV therapy in patients with moderate to severe predominant central sleep apnea and symptomatic chronic heart failure with reduced ejection fraction.
http://www.resmed.com/us/en/consumer/ne ... erapy.html

my heart palpitations have probably gotten worse

What are you describing as heart palpitations?

icipher wrote:I don't know if I have heart problems or not. I had some tests done which came back negative

What tests did you have done, and what type doctors performed these tests?

My heart palpitations range from a sudden strong sensation i feel in my chest and throat which jolts me, to something as bad as a spasm in my lower sternum that comes on and off in intervals lasting about three seconds each.

I have had an ekg and an echocardiogram. My ejection fraction was 58 i believe. I don't know if that is considered good or what.

Pugsy wrote:It potentially affects people with congestive heart failure with ejection rates less than 45 I think it was.
Discussed earlier this summer I think it was on the forum.
Have you ever had a cardiac echocardiagram?
My understanding is the risk is increased with people who already have damaged hearts but that it doesn't cause the damage.

Hi Pugsy,

Yes, I have indeed had an echocardiogram about 2 years ago when i was diagnosed with central apnea. It came back "fine" with an ejection fraction of 58.

icipher wrote:My ejection fraction was 58 i believe. I don't know if that is considered good or what.

A normal LVEF ranges from 55-70%.

Please see this article, in particular the table near the middle of the article. http://my.clevelandclinic.org/services/ ... onfraction

Although this is an older thread, I'm posting here because I can't find the original one.
So, pressing on, here is a link to a new study that is on point.
https://www.ncbi.nlm.nih.gov/pubmed/30059750
https://me.resmed.com/healthcare-profes ... -hf-study/
https://www.prnewswire.com/news-release ... 82445.html

Other links on this topic:
https://erj.ersjournals.com/content/50/2/1601692
http://my.clevelandclinic.org/services/ ... onfraction
https://www.resmed.com/epn/en/healthcar ... sults.html


ResMed is announcing the resumption of Phase IV of the HF-Serve Study.

What you're describing as palpitations might simply be 'ectopic beats'. These are pretty common and usually harmless, though if frequent and strong, they can be quite alarming. It feels like your heart takes a pause, then goes a little berserk for a few beats while it plays catch-up. That's how mine feel anyway. They are occasionally so powerful that I feel slight pain.

I have suffered ectopic beats for most of my life and they became more frequent after my heart attack in 2008. They tend to happen much more when I'm under stress - there's a strong mental aspect whereby you might not have any for quite a while but then have a few big ones all in a row, whereafter you worry a bit, which makes them worse, which makes you worry more, which ...

Nevertheless, as uncomfortable as they can be, they are rarely any cause for alarm.

They're notoriously hard to diagnose. Because they are infrequent, there's a good chance they won't happen when a doctor is listening or for the 30mins or so that you're wired up in A&E. If you really want a diagnosis and your docs can't detect your palpitations, the best thing is to be fitted with halter-type ECG for 24hrs, which has a much higher chance of recording an event.

SERVE-HF was a terribly done study, absurdly low standards for 'treatment' and compliance. Compared to the standards we have here, the ASV users in the cohort were as good as untreated.

http://www.sciencedirect.com/science/ar ... 9215003505