TY - JOUR
T1 - Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes
AU - Morgenthaler, Timothy I.
AU - Gay, Peter C.
AU - Gordon, Nancy
AU - Brown, Lee K.
PY - 2007/4/1
Y1 - 2007/4/1
N2 - Rationale: Although continuous positive airway pressure (CPAP) is most often effective in patients with obstructive sleep apnea, optimal treatment of patients with predominantly mixed apneas, central sleep apnea syndrome/Cheyne-Stokes respiration (CSA/CSR), or complex sleep apnea (CompSAS) is less straightforward, and may require alternative ventilatory assist modalities. Objectives: To compare the efficacy of noninvasive positive pressure ventilation (NPPV) with adaptive servoventilation (ASV) in treating patients with centrally mediated breathing abnormalities. We hypothesized that NPPV and ASV would be equivalently efficacious in improving the apnea/hypopnea index (AHI) and respiratory arousal index (RAI). Methods: Prospective randomized crossover clinical trial comparing NPPV with ASV in patients with CSA/CSR, predominantly mixed apneas, and CompSAS in an acute setting. Measurements and Main Results: 21 patients (6 with CSA/CSR, 6 with predominantly mixed apneas, and 9 with CompSAS) with initial diagnostic AHI ± standard deviation 51.9 ± 22.8/hr and RAI 45.5 ± 26.5/hr completed the study. Following optimal titration with CPAP (N=15), disturbed breathing and disturbed sleep remained high with mean AHI= 34.3 ± 25.7 and RAI=32.1 ± 29.7. AHI and RAI were markedly reduced with both NPPV (6.2 ± 7.6 and 6.4 ± 8.2) and ASV (0.8 ± 2.4 and 2.4 ± 4.5). Treatment AHI and RAI were both significantly lower using ASV (P <0.01). Conclusions: These data confirm that in patients with CSA/CSR, mixed apneas, and CompSAS, both NPPV and ASV are effective in normalizing breathing and sleep parameters, and that ASV does so more effectively than NPPV in these types of patients.
AB - Rationale: Although continuous positive airway pressure (CPAP) is most often effective in patients with obstructive sleep apnea, optimal treatment of patients with predominantly mixed apneas, central sleep apnea syndrome/Cheyne-Stokes respiration (CSA/CSR), or complex sleep apnea (CompSAS) is less straightforward, and may require alternative ventilatory assist modalities. Objectives: To compare the efficacy of noninvasive positive pressure ventilation (NPPV) with adaptive servoventilation (ASV) in treating patients with centrally mediated breathing abnormalities. We hypothesized that NPPV and ASV would be equivalently efficacious in improving the apnea/hypopnea index (AHI) and respiratory arousal index (RAI). Methods: Prospective randomized crossover clinical trial comparing NPPV with ASV in patients with CSA/CSR, predominantly mixed apneas, and CompSAS in an acute setting. Measurements and Main Results: 21 patients (6 with CSA/CSR, 6 with predominantly mixed apneas, and 9 with CompSAS) with initial diagnostic AHI ± standard deviation 51.9 ± 22.8/hr and RAI 45.5 ± 26.5/hr completed the study. Following optimal titration with CPAP (N=15), disturbed breathing and disturbed sleep remained high with mean AHI= 34.3 ± 25.7 and RAI=32.1 ± 29.7. AHI and RAI were markedly reduced with both NPPV (6.2 ± 7.6 and 6.4 ± 8.2) and ASV (0.8 ± 2.4 and 2.4 ± 4.5). Treatment AHI and RAI were both significantly lower using ASV (P <0.01). Conclusions: These data confirm that in patients with CSA/CSR, mixed apneas, and CompSAS, both NPPV and ASV are effective in normalizing breathing and sleep parameters, and that ASV does so more effectively than NPPV in these types of patients.
KW - Adaptive servoventilation
KW - Bilevel ventilation
KW - Central sleep apnea syndrome
KW - Cheyne-Stokes respiration
KW - Intermittent positive pressure ventilation
UR - http://www.scopus.com/inward/record.url?scp=34247642594&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34247642594&partnerID=8YFLogxK
U2 - 10.1093/sleep/30.4.468
DO - 10.1093/sleep/30.4.468
M3 - Article
C2 - 17520791
AN - SCOPUS:34247642594
SN - 0161-8105
VL - 30
SP - 468
EP - 475
JO - Sleep
JF - Sleep
IS - 4
ER -