Adaptive servoventilation in patients with central or complex sleep apnea related to chronic opioid use and congestive heart failure

Study Objectives: Adaptive servoventilation (ASV) is often used to treat central sleep apnea (CSA) and complex sleep apnea syndrome (CompSAS). Both CompSAS and CSA may occur in the setting of CHF and with the use of chronic opioids. We hypothesized that ASV would be less successful in treatment of CSA and CompSAS secondary to opioid use than in CHF patients. Methods: Consecutive patients were studied between January and December 2009 who underwent ASV titration for CSA or CompSAS due to CHF (defi ned as EF < 45%, or > 50% with evidence for diastolic dysfunction on echocardiogram) and chronic opioid users (defi ned by the use of opioids > 6 months). Results: Study included one hundred and eight patients with 77 males (71.3%) and 31 females (28.7%). Subjects had severe sleep apnea at baseline (AHI 45.6 ± 27.4) and inadequate control of sleep disordered breathing on CPAP (AHI 50.0 ± 32.2, CAI 36.6 ± 32). No signifi cant differences were found between the groups in overall ASV success, defi ned as AHI < 10/h (p = 0.236). ASV was successful in 28 (59.6%) of those in the opioid group, compared to 43 (70.5%) of those in the CHF group. When ASV success was defi ned as AHI < 5/h at optimum EEP, there was again no signifi cant difference between the groups (p-value = 0.812). Logistic regression showed unit increases in BMI, unit increases in HCO3, and presence of CSR were each associated with decreased likelihood of ASV success. Conclusion: We did not fi nd a statistically signifi cant difference in the effectiveness of ASV between CHF patients and chronic opioid users, with the overall success rate approaching 70%, as defi ned by an AHI < 10/h.