TY - JOUR
T1 - Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes
AU - Allam, Joanne Shirine
AU - Olson, Eric J.
AU - Gay, Peter C.
AU - Morgenthaler, Timothy I.
N1 - Funding Information:
Dr. Morgenthaler received a loan of equipment from Olympus for study on vocal cord visualization during sleep, a loan of equipment from SenTec for different research protocol, and equipment and financial support from ResMed Inc, in 2004 for a different protocol. Dr. Gay received equipment from ResMed Inc., for study of ASV in a different research protocol, and equipment and financial support from 2004 to 2005.
PY - 2007/12
Y1 - 2007/12
N2 - Background: Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV. Methods: Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center. Results: ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AHI < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality. Conclusion: The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.
AB - Background: Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV. Methods: Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center. Results: ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AHI < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality. Conclusion: The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.
KW - Adaptive servoventilation
KW - Central sleep apnea
KW - Complex sleep apnea
KW - Positive pressure breathing
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U2 - 10.1378/chest.07-1715
DO - 10.1378/chest.07-1715
M3 - Article
C2 - 18079219
AN - SCOPUS:37549000575
SN - 0012-3692
VL - 132
SP - 1839
EP - 1846
JO - Chest
JF - Chest
IS - 6
ER -