Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management

Kannan Ramar, Benoît Desrues, Priya Ramar, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Adaptive servo-ventilation (ASV) is used to treat complex sleep apnea syndrome (CompSAS), but with variable success. Factors influencing success are poorly understood. ASV devices determine their output based upon characteristics of a given breath and on proprietary algorithms that assume a periodic breathing pattern. Periodic breathing patterns produce elevated narrow band low-frequency cardiopulmonary coupling (eNB-LFC). Therefore, we hypothesized that ASV success would correlate with elevated proportions of periodic breathing as marked by eNB-LFC on cardiopulmonary coupling (CPC) analysis. Methods: This was a retrospective study of 106 consecutive patients presenting to an academic tertiary care sleep center with CompSAS between July 2008 and July 2009 who underwent ASV titration with polysomnographic signals amenable to CPC analysis. Results: The study included 89 males (84 %) and 17 females (16 %), with mean age of 63.3 years. Median diagnostic apnea-hypopnea index (AHI) was 38 (21, 56)/h, and on continuous positive airway pressure (CPAP), the median residual AHI (CompSAS) was 36.5 (23, 58)/h, with central apneas occurring on average 22.5 (13, 39)/h. ASV brought AHI to 11.0 ± 13.0, with success in 81.1 % of patients, as defined by an AHI of <10/h. NB-LFC was elevated (>0) in 45.3 %; however, the percentage of eNB-LFC did not correlate with ASV treatment success (p = 0.518). No clinical factors were found to be associated with ASV success. Conclusion: ASV was successful in 81 % of patients with CompSAS. However, eNB-LFC calculated from CPC, a marker for periodic breathing, did not correlate with ASV success and therefore may not be a useful tool to predict ASV success.

Original languageEnglish (US)
Pages (from-to)861-866
Number of pages6
JournalSleep and Breathing
Volume17
Issue number2
DOIs
StatePublished - May 2013

Fingerprint

Sleep Apnea Syndromes
Ventilation
Apnea
Respiration
Central Sleep Apnea
Continuous Positive Airway Pressure
Tertiary Care Centers
Sleep
Retrospective Studies
Equipment and Supplies

Keywords

  • Adaptive servo-ventilation
  • Cardiopulmonary coupling
  • Central sleep apnea
  • Complex sleep apnea

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology

Cite this

Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management. / Ramar, Kannan; Desrues, Benoît; Ramar, Priya; Morgenthaler, Timothy Ian.

In: Sleep and Breathing, Vol. 17, No. 2, 05.2013, p. 861-866.

Research output: Contribution to journalArticle

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abstract = "Background: Adaptive servo-ventilation (ASV) is used to treat complex sleep apnea syndrome (CompSAS), but with variable success. Factors influencing success are poorly understood. ASV devices determine their output based upon characteristics of a given breath and on proprietary algorithms that assume a periodic breathing pattern. Periodic breathing patterns produce elevated narrow band low-frequency cardiopulmonary coupling (eNB-LFC). Therefore, we hypothesized that ASV success would correlate with elevated proportions of periodic breathing as marked by eNB-LFC on cardiopulmonary coupling (CPC) analysis. Methods: This was a retrospective study of 106 consecutive patients presenting to an academic tertiary care sleep center with CompSAS between July 2008 and July 2009 who underwent ASV titration with polysomnographic signals amenable to CPC analysis. Results: The study included 89 males (84 {\%}) and 17 females (16 {\%}), with mean age of 63.3 years. Median diagnostic apnea-hypopnea index (AHI) was 38 (21, 56)/h, and on continuous positive airway pressure (CPAP), the median residual AHI (CompSAS) was 36.5 (23, 58)/h, with central apneas occurring on average 22.5 (13, 39)/h. ASV brought AHI to 11.0 ± 13.0, with success in 81.1 {\%} of patients, as defined by an AHI of <10/h. NB-LFC was elevated (>0) in 45.3 {\%}; however, the percentage of eNB-LFC did not correlate with ASV treatment success (p = 0.518). No clinical factors were found to be associated with ASV success. Conclusion: ASV was successful in 81 {\%} of patients with CompSAS. However, eNB-LFC calculated from CPC, a marker for periodic breathing, did not correlate with ASV success and therefore may not be a useful tool to predict ASV success.",
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