Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep

Johnson, Karin G.; Johnson, Douglas C.

doi:10.1378/chest.128.4.2141

Cited by 115 publications

(51 citation statements)

References 30 publications

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“…Another study demonstrated that Bi-PAP increased the frequency and severity of CSA due to instability of the respiratory pattern and elevation of the apneic threshold. 22) In the present study, patients with higher PCWP had a greater increase in SVI by ASV. ASV could reduce preload Heart rate (beats/minute) 66.3 ± 10.4 63.5 ± 9.1 65.8 ± 9.9 66.6 ± 10.7 65.2 ± 9.6 66.6 ± 10. and also functional mitral regurgitation (MR) by changing the morphology of the heart, which can lead to an increase in forward SV in HF patients with higher PCWP.…”

Section: Discussionsupporting

confidence: 51%

Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure

et al. 2015

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SummaryAdaptive servo-ventilation (ASV) has been attracting attention as a novel respiratory support therapy for heart failure (HF). However, the acute hemodynamic effects have not been compared between ASV and continuous positive airway pressure (CPAP) in HF patients.We studied 12 consecutive patients with stable chronic HF. Hemodynamic measurement was performed by right heart catheterization before and after CPAP 5 cmH 2 O, CPAP 10 cmH 2 O, and ASV for 15 minutes each.Heart rate, blood pressure, pulmonary capillary wedge pressure (PCWP), and stroke volume index (SVI) were not changed by any intervention. Right atrial pressure significantly increased after CPAP 10 cmH 2 O (3.6 ± 3.3 to 6.7 ± 1.6 mmHg, P = 0.005) and ASV (4.1 ± 2.6 to 6.8 ± 1.5 mmHg, P = 0.026). Cardiac index was significantly decreased by CPAP 10 cmH 2 O (2.3 ± 0.4 to 1.9 ± 0.3 L/minute/m 2 , P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m 2 , P = 0.299). There was a significant positive correlation between baseline PCWP and % of baseline SVI by CPAP 10 cmH 2 O (r = 0.705, P < 0.001) and ASV (r = 0.750, P < 0.001). ASV and CPAP 10 cmH 2 O had significantly greater slopes of this correlation than CPAP 5 cmH 2 O, suggesting that patients with higher PCWP had a greater increase in SVI by ASV and CPAP 10 cmH 2 O. The relationship between baseline PCWP and % of baseline SVI by ASV was shifted upwards compared to CPAP 10 cmH 2 O. Furthermore, based on the results of a questionnaire, patients accepted CPAP 5 cmH 2 O and ASV more favorably compared to CPAP 10 cmH 2 O.ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients. (Int Heart J 2015; 56: 527-532)

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Section: Discussionsupporting

confidence: 51%

Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure

et al. 2015

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“…When BPAP is used, inspiratory PAP can lead to augmented tidal volumes, which decrease PaCO 2 [12]. If the PaCO 2 falls below the CO 2 apnea threshold, CSA may ensue.…”

Section: Pathophysiologymentioning

confidence: 99%

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

BaHammam

2017

Sleep Vigilance

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Treatment-emergent central sleep apnea (TECSA) is a distinct form of sleep-disordered breathing characterized by the development of central sleep apnea during the initiation of positive airway pressure (PAP) therapy in patients with obstructive sleep apnea. The exact mechanisms of TECSA are not clearly known; however, several theories have been proposed. Usually, TECSA is transient and self-limited, and disappears after continued PAP use. Nevertheless, patients with persistent TECSA have lower adherence to PAP therapy and are more likely to terminate therapy. Close follow up is necessary to assure that the emergent central events disappear with continued therapy. In patients with persistent TECSA, more advanced algorithms such as adaptive servo-ventilation have been shown to be very effective. In this brief review, we summarize the definition, prevalence, predictors, pathophysiology, and treatment approaches of TECSA.

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“…Another small retrospective case series of patients titrated to ASV for treatment-emergent central sleep apnea that did not get better with CPAP therapy found that ASV could achieve an AHI <5/h in 80 % of patients and less than 10/h in 92 %, with the average AHI going from 44.4/h on standard PAP to 3.6/h on ASV [57]. Bi-level positive airway pressure (BPAP) can be considered to treat patients with CompSAS; however, there has been some association with worsening central apneas [58]. A randomized controlled trial comparing BPAP and ASV showed that after 6 weeks, ASV was clearly superior with regards to residual AHI and elimination of central events [59].…”

Section: Asv For Treatment-emergent Central Sleep Apneamentioning

confidence: 99%

Advanced Positive Airway Pressure Modalities

Bierer¹,

Ryden

Aysola³

2015

Curr Sleep Medicine Rep

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Auto-adjusting positive airway pressure (PAP) devices are increasingly becoming the first line treatment for obstructive sleep apnea (OSA). More complex sleepdisordered breathing such as Cheyne-Stokes respirations and central sleep apnea related to heart failure as well as complex sleep-disordered breathing related to chronic hypoventilation syndromes may require the use of advanced positive airway pressure modalities such as automated servo ventilation (ASV) and volume targeted pressure limited ventilation. Identifying patients with complex sleep-disordered breathing that will benefit from treatment with advanced modalities remains an area of active investigation. A recent and surprising development found ASV to be associated with an increased risk of sudden cardiac death when used to treat central sleep apnea in patients with symptomatic systolic heart failure and an ejection fraction less than 45 %. The optimal treatment of central sleep apnea in heart failure and the role of ASV are currently in question. The following chapter is intended to provide the clinician with a description of newer PAP modalities; a review of evidence supported indications for use as well as provide a framework for managing patients with advanced positive airway pressure therapy.

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Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep

Cited by 115 publications

References 30 publications

Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure

Adaptive Servo-Ventilation Has More Favorable Acute Effects on Hemodynamics Than Continuous Positive Airway Pressure in Patients With Heart Failure

Treatment-Emergent Central Sleep Apnea (Complex Sleep Apnea)

Advanced Positive Airway Pressure Modalities

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