Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes

Timothy Ian Morgenthaler, Peter C. Gay, Nancy Gordon, Lee K. Brown

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)468-475
Number of pages8
JournalSleep
Volume30
Issue number4
StatePublished - Apr 1 2007

Fingerprint

Positive-Pressure Respiration
Sleep Apnea Syndromes
Apnea
Cheyne-Stokes Respiration
Central Sleep Apnea
Arousal
Respiration
Continuous Positive Airway Pressure
Sleep
Obstructive Sleep Apnea
Cross-Over Studies
Randomized Controlled Trials
Therapeutics

Keywords

  • Adaptive servoventilation
  • Bilevel ventilation
  • Central sleep apnea syndrome
  • Cheyne-Stokes respiration
  • Intermittent positive pressure ventilation

ASJC Scopus subject areas

  • Physiology

Cite this

Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. / Morgenthaler, Timothy Ian; Gay, Peter C.; Gordon, Nancy; Brown, Lee K.

In: Sleep, Vol. 30, No. 4, 01.04.2007, p. 468-475.

Research output: Contribution to journalArticle

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abstract = "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.",
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