III: Harm B-R In patients with NYHA class II IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm.203 NEW: New data demonstrate a signal of harm when adaptive servo-ventilation is used for central sleep apnea. See Online Data Supplement G. Mortality rate (all cause and cardiovascular) was higher with adaptive servo-ventilation plus GDMT than with GDMT alone in a single RCT to test the addition of adaptive servo-ventilation ( 5 hours/night, 7 days/week) to GDMT in patients with HFrEF and central sleep apnea.203 A similar risk has been seen in another trial, and a third trial of adaptive servo-ventilation in central sleep apnea and HF was aborted because of ethical concerns. The weight of evidence does not support the use of adaptive servo-ventilation for central sleep apnea in HFrEF. Recommendations for Treatment of Sleep Disorders (Continued) COR LOE Recommendations Comment/Rationale 2017 ACC/AHA/HFSA Heart Failure Focused Update CLINICAL STATEMENTS AND GUIDELINES REFERENCES 1. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Institute of Medicine (US). Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press, 2011. 2. Committee on Standards for Systematic Reviews of Comparative Ef- fectiveness Research, Institute of Medicine (US). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: National Academies Press, 2011. 3. Anderson JL, Heidenreich PA, Barnett PG, et al. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Prac- tice Guidelines. Circulation. 2014;129:2329 45. 4. ACCF/AHA Task Force on Practice Guidelines. Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines; 2010. American College of Cardiology and American Heart Association. Available at: http://my.americanheart.org/idc/groups/ahamah-public/@ wcm/@sop/documents/downloadable/ucm_319826.pdf Accessed May 5, 2017. 5. 