Comparative Effectiveness of Therapies for Sleep-Disordered Breathing in Heart Failure Patients: A Comprehensive Systematic Review and Network Meta-Analysis

The prevalence of sleep-disordered breathing (SDB) in patients with heart failure (HF) is a significant concern, leading to adverse outcomes. This network meta-analysis (NMA) is dedicated to evaluate the relative effectiveness of diverse therapeutic approaches for SDB treatments in the context of HF. An extensive search up to May 19, 2023, was implemented in PubMed, Cochrane, Embase, and Web of Science to identify randomized controlled trials (RCTs). These trials compared adaptive servo ventilation (ASV), automatic positive airway pressure (APAP), Bi-level positive pressure ventilation (Bi-level PPV), continuous positive airway pressure (CPAP), and oxygen therapy against placebo or standard treatment. Key outcomes included cardiac function indicators (left ventricular ejection fraction [LVEF], plasma B-type natriuretic peptide [BNP] levels), polysomnography data (apnea-hypopnea index [AHI], Mean and Minimum Oxygen Saturation), and patient-reported quality of life measures (Epworth sleepiness scale [ESS]). A random-effects Bayesian NMA was utilized to evaluate and compare the efficacy of these interventions. The study revealed significant therapeutic effects of different interventions in sleep apnea patients. For patients with obstructive sleep apnea (OSA), CPAP demonstrated superior efficacy in enhancing average oxygen saturation (mean difference (MD) = 0.98; 95% credible interval (CI) [0.07,2.09]), improving LVEF (MD= 5.66; 95% CI [0.71, 10.08]), and reducing AHI (MD= -20.61; 95% CI [-33.84, -9.9]). In the case of central sleep apnea (CSA), the therapeutic approaches showed varying degrees of effectiveness. CPAP proved most effective for enhancing average oxygen saturation(MD= 1.1; 95% CI [0.26,1.98]). ASV was the most effective in lowering AHI (MD = -32.11; 95% CI [-47.5, -17.16]), increasing lowest oxygen saturation (MD =8.14; 95% CI [1.72,14.92]), and enhancing LVEF (MD =6.58; 95% CI [0.06,12.49]). No single SDB treatment uniformly benefits all clinical indicators in SDB and HF patients.